Everyone gets a cough every now and then, usually during colds and other minor illnesses.  Some people, however, have chronic cough, which is defined as a cough that lasts over 8 weeks in adults, or 4 weeks in children.  Most people with chronic cough have tried the usual over the counter remedies such as Robitussin and have not gotten any relief.

Chronic cough can be caused by a large list of possible problems.  The majority of chronic cough, however, is caused by one or a combination of these 4 problems:

• Nasal allergies causing postnasal drip into the throat
• Acid reflux from the stomach into the throat
• Asthma
• Smoking

When I evaluate a new patient with chronic cough, I first talk to them and ask about any history of these problems and also ask about common associated symptoms, especially acid reflux symptoms.  On physical exam, I will examine the back of the throat and the voice box using a thin flexible endoscope that I can pass through the patient’s nose.  There are classic signs of acid reflux that can be seen in the throat using the flexible endoscope- typically swelling in the back half of the voice box and “cobblestone” appearance of the back wall of the throat.

Once I’ve made a full evaluation, I will plan to treat any of the underlying problems (allergies, asthma, and/or reflux) with medication and will instruct any smokers to quit.  If people continue smoking, they cannot expect that their cough will ever get better.

I will usually see patients back a few weeks later, and a lot of them get better.  However, some do not.  These patients may need adjustment of their medication doses, but I will usually at this point consider the possibility of more unusual diagnoses such as neurogenic cough or lung disorders.

Neurogenic cough is a chronic cough caused by abnormal nerve activity to the voice box.  Patients will usually complain of a constant tickle in the throat with recurrent spells of dry coughing.  There are medications that can successfully suppress this type of cough.  These include tramadol (a type of pain medication), gabapentin (also used for nerve pain and seizure prevention), and nortriptyline (also used for migraine prevention and as an antidepressant).

If I have suspicion for any lung problem, I will order a chest X-ray and possibly refer the patient to a pulmonary specialist at this point.

Chronic cough can be a very difficult problem to deal with, but fortunately most patients can be treated successfully once their underlying issue is diagnosed and dealt with.