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Woman Coughing

A noisy, chronic cough is not only uncomfortable, but it’s also unbearable for those around you such as family and co-workers.

We mostly tend to think of a cough related to an infection, which would respond to an antibiotic. In many cases, this is erroneous thinking. It is easy to fall into this trap whether you are a patient or a physician. But I’ve learned in my over 20 years of practice to be especially careful in evaluating a chronic cough because there are so many underlying causes that can be at the root of the problem.

4 Essential Areas to Think About That Might Be Causing Your Cough:

1) Allergens:

A small girl playing with her kitten

If you didn’t have a fever at the beginning of a cough, then it probably isn’t an infection. Yes, there are situations where fever may be mild and overlooked, but usually, a significant fever with a cough will point to a viral or bacterial infection. However, if it’s not present, then I start to review very carefully with the patient for underlying allergic triggers.
Environmental allergens, such as dust, mold, animals can all affect the respiratory system. In the winter months, these indoor allergens can be even more intense because we tend to spend so much more time indoors.

I have seen patients whose cough started when they began to raise the indoor heat and became more exposed to dust from the heating vents in their homes. Allergies can be easily identified with allergy testing through the skin or blood. The key point is that if an allergen is causing the bronchioles to spasm causing a cough, then a simple inhaler with mild cortisone and a bronchodilator can bring immediate relief. Long term relief can be found with sublingual allergy drops done at home.

2) Sinus Inflammation

Sinus Inflamation

Notice I called this sinus inflammation, not a sinus infection. Once again, sinus bacterial infections are overdiagnosed and this leads to overuse of antibiotics- which creates other problems with the gut and immune system.

Sinus inflammation can mean that allergens or irritants are triggering an immune response that causes mucus production. The mucus which is responding to this inflammation can trigger the cough reflex in the back of the throat. Also, if the mucus drains down into the lungs you will experience the need to cough to clear out the lungs. The goal of sinus inflammation is to reduce it with intranasal cortisone sprays. Mucolytics such as Mucinex-DM can also be helpful for a short period.

If the underlying inflammation is due to an allergen, again sublingual allergy drops can make a significant impact to prevent it from occurring. Interestingly, I also see many patients that have fungal hypersensitivity with Candida albicans who have sinus inflammation. Here, I need to adjust the patient’s diet to go off wheat, dairy and sugar products. I will also use antifungal medications and Candida drops to keep the sinuses clean.

3) Gastric Reflux

Woman suffering gas problem

A very tricky medical problem is gastric reflux. In some cases, it can be very obvious to the patient: intense heartburn, chest pain and a bad taste in their throat and mouth. In other cases, it can be what’s called silent reflux- this is where a patient doesn’t have the classic symptoms of gastric reflux but only has either a chronic cough or a hoarse voice.

The stomach and the lungs are both innervated by the vagus nerve that comes from the brain. If this nerve is aggravated it can simultaneously cause excessive acid production and at the same time cause the lungs to spasm. The lungs do this to protect itself from the excessive acid harming its tissue. Treating gastric reflux may seem obvious but it isn’t (see prior post on President Obama: You Can Beat HeartburnNaturally). For immediate relief, antacids and acid blockers are helpful, but the long term solution is dietary changes and lifestyle techniques to reduce stress reduction.

4) Neurologic/Psychological Disorders

Man sitting in stress

There is a range of these types of conditions where the only presenting sign is initially a chronic cough. The concept is similar to a stutter or a facial tic. It is sometimes hard to overcome the stigma of having a psychological condition, but by being appropriately diagnosed, a person’s quality of life can be dramatically improved. Interestingly, certain antidepressants such as Elavil have been found to be effective in relieving a chronic cough.

My experience as an allergist/immunologist treating chronic cough can be difficult but extremely rewarding for the patient.

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island