The nagging cough

“I’ve got this cough that just won’t go away,” my patient says, and I know this story all too well. Chronic cough, a cough that lasts more than two months, is a common ailment which in most cases is benign. But for the patient it is both bothersome and worrisome.

If your cough has lasted for less than two months it may just be the residual effect of an upper respiratory infection. Dry cough after having one of many viruses can last for weeks and weeks and the only cure is time.

In patients who do have chronic cough, my first task is taking a good history. Are or were they a heavy smoker? If so, I will be more apt to rule out cancer and consider lung imaging. I will also be suspicious of chronic obstructive pulmonary disease which can be diagnosed by breathing tests. But many of these patients have no or little smoking history so are at low risk for those things. Why are they coughing? I can think of a few common reasons.

Mild asthma often causes cough at nighttime, in the cold, or with activity; it isn’t always accompanied by wheezing. Simple breathing tests in the office can help us diagnose asthma and it can be greatly helped with inhaled medications.

Post-nasal drip is extremely common and we have probably all experienced it with a cold or allergies. For patients who have this chronically, the mucous produced in the nose drains down the throat, causing irritation to the upper airway and an annoying cough. If this seems likely, I suggest the patient tries a steroid nasal spray every day for a month or two, and if that resolves the cough we have our answer.

Gastroesophageal reflux disease, or GERD, doesn’t always cause classic heartburn. As the stomach acid creeps up the esophagus, especially when lying flat at night, it can get high enough to irritate the upper airway and cause cough. As with post-nasal drip, sometimes we just try treating this ailment with an acid reducing medication for a couple months to see if this cures the cough.

Finally, a commonly used type of medication can actually cause benign cough as a side effect. ACE inhibitors like lisinopril are excellent drugs for hypertension and heart disease, but around 5 to 10% of people will get a dry cough with it. If so, the cough resolves when we stop the med.

Back to my patient. “Tell me more about your cough,” I say. “I’m confident we can figure out what is going on, even if it takes a little time.”

Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. Follow The Prairie Doc® at http://www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central.