Why Will My Cough Not Go Away?

Chronic cough is one of the most common complaints seen by a lung doctor that can

significantly impact quality of life.  The causes for a chronic cough are quite variable and require

a thorough history starting by reviewing the medication list (ACE inhibitors) as well as identifying whether the patient smokes. Inquiring about environmental irritants is imperative and determining if the cough intensity worsens with repetitive re-exposures.  Symptomatic or even asymptomatic reflux can cause coughing as well as undiagnosed asthma presenting as "cough variant asthma".  Patients with known asthma, chronic bronchitis or bronchiectasis commonly struggle with chronic cough. Asthma is often confirmed by spirometry or a test called a methacholine challenge. 

Postnasal drip, now called upper airway cough syndrome, is due to upper airway irritation and hypersensitivity of the cough receptors which can steam from sinusitis, to allergic or nonallergic rhinitis, to postinfectious causes and even vasomotor and drug-induced rhinitis.

Allergy related rhinitis is best treated with the newer generation antihistamines or nasal steroids that can be obtained over the counter. Nonallergic related rhinitis respond best to older generation antihistamines like Benadryl and decongestant combinations. Vasomotor rhinitis will respond to nasal ipratropium and post infective rhinitis responds best to a combination of antihistamine-decongestant. If the cough does not resolve within two weeks you may have a secondary bacterial sinusitis. 

Avoiding getting sick is a key strategy in preventing a chronic cough. One of the key ways to avoid getting sick is to use a natural product call Xylitol. This is a naturally occurring sugar that has antiviral properties and if taken prophylactically prior to exposures to large crowds it can often keep you from getting sick. Using it before boarding and after flying on an airplane would be a great idea.  Xylitol is contained in several over-the-counter formulations and can be purchased off the internet. 

Treatment of reflux starts with life style changes by avoiding foods that exacerbate reflux such as spicy foods, tomato-based foods, chocolate, peppermint, as well as elevating the head of your bed. Weight loss will also help with reflux symptoms. Medical treatment may include acid suppressing agents but there are now new theories suggesting that perhaps not enough acid is contributing to reflux leading to poor digestion. Resolution of a cough due to reflux may take a few months after starting treatment. Also, note that untreated obstructive sleep apnea severely worsens reflux and should be addressed at the same time if present. 

A good resource for natural remedies for treating a cough: Cough Cures: The complete guide to the best natural remedies and over-the-counter drugs for acute and chronic cough” by Gustavo Ferrar, MD