By Elaine Turner, M.D., FACP
Here at VAPA, we frequently see people who come in with a complaint of chronic cough. Often, the cough has lasted for at least 6 weeks and may be keeping the person from sleeping at night. Generally there are 5 different causes of cough that we need to rule out.
A frequent cause of cough is postnasal drip. This can be caused from a chronic inflammation of the nose due to allergies or to a condition that we call non-allergic rhinitis, a chronic inflammation of the nose not caused by allergies. Allergic rhinitis can be triggered by pollens, molds, house dust mite or animal dander. Non-allergic rhinitis is a chronic inflammation that the nose seems to be generating all on its own. Triggers include strong odors such as perfume, household chemicals, or potpourri; change in temperature; change in body position or even a change in weather conditions.
Another cause of cough is sinusitis. The cough is triggered by a combination of the postnasal drip that accompanies the sinus infection and inflammation of the sinuses which can cause cough by a neurological reflex. Treatment of the sinusitis with an antibiotic and sinus rinses will then relieve the cough.
A third common cause of chronic cough is asthma or reactive airways disease. Asthma is not always accompanied by wheezing. Often, the sole manifestation of a case of asthma can be a chronic cough. Here at VAPA, we always do pulmonary function tests on people suffering from chronic cough. If the initial pulmonary function test is abnormal, the test is then repeated after the patient is given a nebulizer treatment with a bronchodilator. If a parameter called the FEV1 improves by 12% or more, it is considered diagnostic of asthma or "reactive airways disease." Treatment with inhaled corticosteroids, possibly with the addition of long-acting bronchodilators will generally relieve the cough.
A fourth cause of chronic cough is gastroesophageal reflux disease or GERD. The patient may complain of frequent heartburn or burning sensation in the chest, particularly exacerbated by a large meal. Sometimes there can be reflux disease that is asymptomatic except for a cough. In other words, the patient does not notice any heartburn but just has the cough. This is treated by a class of medication called proton pump inhibitors. Examples of this kind of medication include Prilosec, Nexium, Prevacid and others. Treatment needs to continue for at least two months at sufficient dosage before we can be sure that it is not working.
Finally, chronic cough can be a side effect of a class of blood pressure medicine called ACE inhibitors. Examples of this kind of medication include lisinopril and enalapril. Generally, the generic name for any of the ACE inhibitors will end in "-pril.” Stopping the medication for a trial period is often helpful in determining whether the cough could be due to taking the medication.
These various conditions need to be ruled out one by one in teasing out the cause of a chronic cough. At VAPA, we see cases of chronic cough frequently and are experienced in treating people who have this problem.
Dr. Elaine Turner, M.D., FACP has been treating patients at VAPA for more than 8 years. "FACP” stands for "Fellow of the American College of Physicians" and is a designation awarded for quality of research and educational activities. Dr. Turner has held faculty physicians at several medical schools, including Northwestern, Rush Presbyterian, Cornell and VCU. She has been a frequent speaker to other physicians and community groups and has published several papers and peer-reviewed medical journals. |