Chronic cough – Such a frustrating problem! A chronic cough can lead to embarrassing situations, like people always asking if you are okay or sick, or if you’re afraid to go to theaters or out to dinner. Even worse, coughing can damage your body: fractures, broken blood vessels, incontinence, and for singers, vocal hemorrhages.
Chronic cough is one of the most common reasons a person visits a physician. Most causes of acute, short-term cough are related to upper respiratory tract infection, asthma, and environmental exposure and allergy. Other causes of cough include acute and chronic sinusitis, medications such as ACE inhibitors – a common blood pressure medication, foreign bodies in children, cancer of the lungs and vocal cords can also present as a chronic cough, and other lung abnormalities.
One lesser known cause of chronic cough in many patients is laryngopharyngeal reflux disease (LPR). LPR is the reflux of the stomach contents into the throat area causing swelling, inflammation, and changes in sensitivity. Chronic LPR can lead to changes in voice, trouble swallowing, globus (a feeling of a lump in the throat), throat clearing, the sensation of post-nasal drip, and chronic cough. A dry cough at night is highly suggestive of LPR.
Another lesser known cause is neurogenic cough. Some people report the onset of a cough, often after a cold months to years prior. This is a dry cough often preceded by a tickle sensation. There can be many triggers: talking, laughing, singing, cold air, dry air, hot air, odors, perfumes, eating, drinking, or just random onset. Often the cough will occur in uncontrollable spasms and can be accompanied by tearing of the eyes, running of the nose, and a strain in the voice. This type of cough is nearly always diagnosed as “cough-variant asthma”. However, this is not asthma!
Another cause of chronic cough is a postviral vagal neuropathy. Post-exposure to a viral infection can cause a chronic cough that is typically dry, occurs throughout the day and night, and can cause spasm of the vocal folds with difficulty breathing (usually during sleep) Cough occurs in conjunction with a “tickle” in the throat, a dry patch sensation, sensitivity to cold air or environmental exposures, irritation in the throat, coughing “fits”, and in severe cases, spasm of the vocal cords.
Treatment should begin with some simple measures such as humidification, changes in environmental exposure, resolution of other cold and flu symptoms, and medications. Medications might include antibiotics, antihistamines for allergy, and other cold medications. If coughing persists, a thorough head and neck examination with endoscopy of the nose and upper airway can help to rule out causes such as sinusitis, vocal cord or throat tumors, laryngopharyngeal reflux disease, and vocal paralysis.
A referral to an allergist may be appropriate especially if other symptoms are present such as itchy, watery eyes, sneezing, headache, nasal stuffiness, post-nasal drip, and noted environmental exposures. A visit to the pulmonologist may be helpful in excluding causes such as asthma, especially the “cough-variant” asthma, pneumonia, and other lung diseases. Other testing may include a chest x-ray, cat-scan, sinus cat-scan, and pulmonary function tests.
For patients who have been treated for more than 3 weeks with little or no change in the pattern of their cough, the diagnosis should be questioned. Patients with laryngopharyngeal reflux disease need dietary changes and proton-pump inhibitors to help with acid suppression. Patients with LPR typically respond in 1-2 months of therapy with resolution of their chronic cough and other LPR symptoms. If a viral neuropathy is causing the cough. Treatment includes the prescription of medications such as amitriptyline.
If you have a chronic cough and have had more than two courses of treatment of any type, you should be evaluated by a laryngologist – a specialist of the vocal cords, throat, and upper airway.
