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Get to the cause of that chronic cough

Published Aug. 7, 2014

We've all been there … you get a constant nagging cough that you can't seem to control. It interrupts you when you are trying to talk and is a nuisance. Most times the cough is temporary, maybe due to a cold or infection. But for some, the cough can be chronic, and there may be several causes.

Let's take Sally, for example. She has had a cough for more than eight weeks, and it interrupts her in conversation and when she is trying to answer phone calls at work. She often feels as if she has to clear her throat. At times, it even bothers her when she is trying to sleep. She does have a history of asthma, though it has been under good control with the proper use of the right medications. On further inquiry, it turns out that Sally also is experiencing postnasal drainage and a runny nose. She also complains of having heartburn once or twice a week.

Usually, cough is normal, as it is actually a protective reflex — your body's normal response to try to eliminate or expel an irritating, foreign matter from the respiratory tract. A cough is considered chronic if it lasts more than eight weeks. Besides smoking, the three major causes for cough are asthma, postnasal drainage and gastroesophageal reflux disease, also known as GERD or acid reflux. Sometimes two or more of these causes occur simultaneously. Here's a closer look at each:

Asthma: One of the symptoms of asthma is cough. Other symptoms include shortness of breath, wheezing and chest tightness. With cough-variant asthma, cough is the only symptom. Asthma is a chronic inflammatory condition that causes the narrowing of the airways and increased mucus production. In order to diagnose asthma, your doctor may do a breathing test called a spirometry, which helps to identify obstruction in the lungs (commonly seen with asthma). Another test is the exhaled nitric oxide test, which measures active inflammation, an indicator of asthma. Asthma treatment consists of using the right medications and avoiding triggers.

Postnasal drainage: When a person has allergies, there is increased mucus production and drainage from the nose and sinuses. This drainage goes down the back of the throat, causing the irritation and inflammation that lead to a cough. One may feel as if he is constantly clearing his throat and coughing to get rid of the drainage. Postnasal drainage can occur with allergies (allergic rhinitis or hay fever) as well as nonallergic rhinitis and sinusitis (sinus infection). An allergist can perform a skin test to see if symptoms are due to allergies. Treatment includes the use of nasal steroid sprays and/or antihistamines. Sometimes allergy shots (immunotherapy) are in order.

GERD: Also known as acid reflux, it can cause heartburn, although most times there is "silent" reflux wherein there may not be any heartburn sensation. GERD occurs when the muscles between the stomach and lower esophagus weaken and the acid from the stomach comes up into the esophagus. The acid travels up and can cause a cough reflex. Your doctor can help diagnose and treat the problem. The best treatment for GERD includes a combination of antacids or antireflux medications and diet and lifestyle modifications.

Medications: These may be the cause of a cough —in particular, ACE inhibitors, which are common blood pressure medications. The cough often begins after starting the medication, but it can occur at any point during the use of the drug. Review your medication list and see if a drug you are taking may be causing the cough.

So ... back to Sally. She had allergy skin tests and was placed on nasal steroids and antihistamines. She also was diagnosed with GERD, which was treated with antireflux medications and diet and lifestyle modifications. Her cough was better within a few weeks.

It's important to remember that cough is a symptom, not a disease. A chronic cough is a signal that there is something going on inside. If you are troubled by a cough that just won't go away, see your doctor to help sort through the problem and come up with a treatment plan that brings you relief.

Dr. Mona V. Mangat and Dr. Ami K. Degala are board-certified allergists and immunologists at Bay Area Allergy & Asthma in St. Petersburg. Find them at bayallergy.com. If you have a question for the doctors, email them at bayallergy@gmail.com. Your question may be answered in a future column.

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