Diagnosis and Treatment of Chronic Cough

Chronic cough is one of the most common complaints in adults seeking medical treatment in an outpatient care setting. In excess of 3.6 billion dollars are spent on over-the-counter medications to treat cough. Fortunately, 90% of people experience successful diagnosis and relief of their symptoms if a systematic and thorough approach is used by their doctor.

What is chronic cough?

Chronic cough is defined as a cough lasting greater than 8 weeks duration. Coughing usually occurs as a defense mechanism to protect and clear our airway of secretions and foreign matter.  A cough can be triggered by chemical, mechanical or thermal stimuli (i.e. foreign body, talking, fumes, cold/hot air, abnormal growths, and irritant particles). People usually seek medical advice for a variety of reasons such as sleep disturbance, chest/rib pain, hoarseness, frequent throat clearing of thick mucus, urinary incontinence, social isolation or fear of a serious underlying condition.

It is important to provide your doctor with a thorough history. You want to tell your doctor if there are any triggers such as being outdoors, swallowing, talking, laughter, walking, running, strong smells, perfumes; or timing of your symptoms such as daytime vs. nighttime, relationship with eating; or any preceding events such as foreign travel, recent upper respiratory tract infection, immigration from a developing country, etc.

What causes chronic cough?

There are multiple possible causes of cough ranging from seasonal allergies, reflux, asthma, certain blood pressure medications, pertussis, foreign body, congestive heart failure, TB, psychogenic, neurogenic, lung cancer, or throat cancer to name some. Fortunately, the cause of the chronic cough in greater than 95% of reasonably healthy immunocompetent nonsmoking adults can be narrowed down to 3 conditions. The three most common causes include post nasal drip cough syndrome (allergic rhinitis/chronic sinusitis), cough-variant asthma, gastro esophageal reflux/laryngoesophageal reflux (reflux from the stomach).

Prior to treatment, your doctor may order some diagnostic tests to help identify to cause. The most common initial noninvasive tests ordered may consist of a chest x-ray, pulmonary function test, sinus CT-scan, esophagram, allergy testing or blood work. Additional more in-depth testing may be required. Your doctor may tell you to stop smoking for at least 1 month or switch your blood pressure medication if you are taking an ACE-inhibitor type drug. Your doctor may also send you to a specialist for assistance such as an ENT doctor, lung doctor, allergist, gastroenterologist, speech pathologist or behavioral therapist.

How do you treat chronic cough?

Treatment is always self-directed towards the most likely cause of the cough. For postnasal drainage syndrome, your doctor will prescribe medications to help break up and stop the mucus production and/or reduce inflammation such as antihistamines, mucolytic agents, decongestants, nasal steroids sprays, saline rinses or ipratropium nasal sprays. Relief from this condition can take up to 2-3 weeks. For cough variant asthma, you may be placed on a combination of inhaled corticosteroids, inhaled beta-agonist, or leukotriene inhibitors. Relief from this condition may take as long as 6-8 weeks. Treatment for cough caused by gastroesophageal/laryngoesophageal reflux may consist of combination of proton pump inhibitors, H2-blockers, dietary/life styles changes or surgery. Response to treatment typically can take as long as 8-12 weeks.

It is very important not to give up treatment too early! It is also important to note that more than one cause may be responsible, and your doctor is your best source to feeling better quickly.

Dr. Daren G. Kest is a board-certified, fellowship trained otolaryngologist with BJC Medical Group practicing at Christian Hospital and Alton Memorial Hospital. He received his medical degree and residency from Michigan State University and fellowship from Indiana University. His office is located at Graham Medical Center 1224 Graham Rd., Ste. 2010, St. Louis, MO 63031. To make an appointment, call 314-953-6093.