Understanding Chronic Cough

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The following is an excerpt from our patient handout entitled, Understanding Chronic Cough. This handout is available to our patients in our practice.

Chronic Cough can be a frustrating problem for patients. A chronic cough is defined as a cough that lasts for more than 8 weeks. There are three major causes for a chronic cough. They include Cough Variant Asthma, Vocal Cord Dysfunction and Postnasal Drip. The drug Lisinopril can also cause a chronic cough. In most cases, there is more than one cause responsible for a chronic cough.

Cough Variant Asthma: Asthma classically presents with expiratory wheezing or shortness of breath. Asthma can also sometimes present solely as a cough. Diagnosis can be made by clinical exam and/or pulmonary function tests. Precipitating factors can be a viral infection or a subclinical bacterial infection. Additional triggers for asthma can include allergies, allergic rhinitis, sinusitis, reflux of stomach acid and irritants such as perfumes and pollution.

Vocal Cord Dysfunction: Vocal cord dysfunction (VCD) is an inflammation of the larynx or upper airway. Symptoms of VCD or Laryngopharyngeal Reflux can include a sense of tightening around your throat, an inability to feel like you can take a deep breath and inspiratory wheezing. Sometimes people feel as if they cannot breathe, start hyperventilating, and as a result, make the symptoms even worse. Symptoms are often misdiagnosed as a panic attack. The diagnosis can be made clinically and confirmed with a Flow Volume Loop or direct visualization with laryngoscopy. Treatment usually involves the use of a proton pump inhibitor (i.e. Pantoprazole, Dexilent), and an H2 antagonist (i.e. Zantac, Pepcid). If non-acid reflux is suspected, other drugs may be prescribed.

Obviously lifestyle measures should be undertaken to prevent reflux. These include the avoidance of acidic foods such as coffee and citrus fruits. Carbonated beverages are also to be avoided as well as chocolate, alcohol and a large intake of fatty foods which can cause relaxation of the lower esophageal sphincter muscles. Avoiding excessive liquids after 6 p.m. and not eating after 8 p.m. is recommended. In order for proton pump inhibitors to work correctly, they need to be taken one half hour before breakfast and one half hour before dinner (with the exception of Dexilent). Sometimes this medical regimen is ineffective and further testing is needed.

Postnasal Drip: Postnasal drip is typically caused by allergic rhinitis, non-allergic rhinitis or sinusitis. People with underlying allergies may have polyps, which can cause obstruction and secondary sinus infections. Treatment includes inhaled nasal steroids, oral antihistamines, nasal antihistamines, saline irrigation, leukotriene antagonists (Singulair) and occasionally, oral steroids. Diagnostic tests include CT scans of the sinuses and allergy testing.

In properly diagnosing chronic cough, we will also generally obtain a chest x-ray to make sure we are not dealing with any chronic lung infection or other possible pulmonary causes for cough. Depending on how difficult it is to make a diagnosis and effectively treat a cough, other testing may be prescribed. While chronic cough can be frustrating, the etiology can be found with a thorough investigation and effective treatment rendered. For more information, make an appointment with us or stop by our office to obtain a copy of one of the following patient handouts: Understanding Vocal Cord Dysfunction, Understanding Asthma, Understanding Allergic Rhinitis or Understanding Gastroesophageal Reflux.

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