Laura is a 55-year-old patient of mine who has had asthma for years. Her symptoms are few, in no small part because she faithfully follows instructions about using her control inhalers every day, no matter whether she feels like she needs the medication or not.
She has not needed oral steroids or antibiotics in years and uses her rescue inhaler — only needed if asthma symptoms really flare — rarely.
But in January, she came into the office, unable to shake a chronic, hacking cough for the previous four weeks. She had recently traveled and thought maybe she'd caught a cold, though none of the over-the-counter remedies she tried did anything to help.
We talked, and it turned out she also was experiencing allergy symptoms like runny nose and postnasal drip, even though it was much earlier in the year than seasonal allergy issues normally arise. She also was having more heartburn than usual.
With warmer temperatures fueling an early spring, I have seen many patients complaining of chronic cough. I've also seen many of my previously well-controlled asthmatics, like Laura, coughing and wheezing.
Having a cough doesn't always mean something is wrong. The cough reflex helps you expel irritating, foreign matter from the respiratory tract. When coughing persists for more than three weeks we call it a chronic cough. Unless you're a smoker, chronic cough has three major causes: postnasal drip, asthma (the most likely of lung diseases that can cause coughing) and gastroesophageal reflux disease, better known as GERD.
Often you can have more than one of these issues at the same time fueling a chronic cough.
• Postnasal drip is a mucous discharge from the upper respiratory tract, usually the nose or sinuses. It can feel like something is caught in your throat. But it can be hard to tell if it's coming from above (upper respiratory tract) or below (gastrointestinal tract).
Postnasal drip is common with allergic rhinitis (hay fever), non-allergic rhinitis or sinusitis. An allergist can help to sort through these diagnoses with a thorough history, physical exam and testing. Often prescription nasal steroid sprays or oral antihistamines help minimize postnasal drip. Antibiotics will be prescribed if there's also a sinus infection present.
• Asthma is a chronic, inflammatory condition affecting the lungs. It leads to irritation and narrowing of the airways, causing cough, shortness of breath, chest tightness and wheezing. Inflamed lungs pump out mucus, and that means chest congestion.
Asthma has been rising since the 1970s and costs more than $20 billion a year to treat in the United States.
Asthma can range from mild to life-threatening. It also can be tricky to diagnose since the common symptoms of cough, wheezing, chest tightness and shortness of breath also are seen in other conditions.
Your doctor may perform some in-office breathing tests like spirometry and exhaled nitric oxide measurements to identify obstruction in the lungs and active inflammation.
Asthma therapy should focus on avoiding triggers, controlling chronic inflammation and treating acute symptoms.
• GERD is the medical term for acid reflux. It's often associated with heartburn, but three out of four GERD patients have a cough, either on its own or along with heartburn.
GERD occurs when the lower muscle between the stomach and esophagus weakens and allows stomach acids to travel upwards into the esophagus, often triggering a cough reflex.
Your doctor may suggest over the counter antacids or prescribe oral acid-reducing drugs. GERD is best treated with a combination of medications, diet and lifestyle modifications that your doctor should help you with.
These three conditions account for the vast majority of chronic cough, but they're not the only possible explanations.
In Laura's case, it took about four weeks to get her cough under control. For her, a combination of an asthma flare plus GERD seemed to stir up her cough reflex. In fact, this season I've seen numerous patients with complex reasons for a chronic cough. Laura required oral steroids, acid-reducing medications and higher doses of her asthma medication.
So if you have a nagging cough, take note of your symptoms and talk to your doctor to find out how you can breathe freely again.
Dr. Mona V. Mangat is a board-certified allergist and immunologist in St. Petersburg at Bay Area Allergy & Asthma. You can find her at www.bayallergy.com.