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The Allergies and Asthma blog has now been retired. We appreciate the wisdom and support Dr. Enright has brought to the WebMD community throughout the years. You can still find great allergy information and support on the WebMD Allergies Health Exchange.

Monday, December 5, 2005

Chronic Cough Workup, Part I

Classic asthma, cough-variant asthma, eosinophilic bronchitis, sino-bronchial syndrome, rhino-sinusitis, atopic cough, multiple-chemical sensitivity, post-viral URI, and GERD can all cause a chronic cough in a non-smoker. The successful treatments differ, so how can a doctor distinguish between them?

An acute cough is defined as lasting less than 3 weeks. A chronic cough has lasted more than 8 weeks (two months). A chronic cough in a cigarette smoker is called chronic bronchitis, and usually disregarded by the smoker. The cure for a smokers’ cough is simple, but rarely employed (smoking cessation). The most common causes of a chronic cough in a non-smoker are asthma, rhinitis with sinusitis and post-nasal drainage (PND), and GERD (gastro-esophageal reflux disease). Most people with a chronic cough just try OTC (over the counter, non-prescription) cough remedies, many of which suppress the brain’s cough reflex (as do opiates like codeine and morphine), but no OTC medication treats the underlying cause of the cough.

A chronic cough can dramatically reduce the quality of life, so some people seek help from a doctor. The characteristics of the cough (dry or wet) and phlegm (thick, thin, or color) are rarely helpful in the diagnosis, but the factors which provoke the cough (if any have been recognized) may provide a clue. Instead of ordering tests to determine the exact cause of the cough, many primary care physicians will take an empiric approach: treat the most likely cause for a few weeks or months, and if that doesn’t work, treat the second most likely cause, and so forth until something seems to work, the cough resolves by itself, or the patient gives up on the process.

When all else fails, patients with a chronic cough may be sent for evaluation by a specialist (pulmonary, allergy, or ENT) who is likely to order tests to determine the exact cause of the cough.

Next in the series: Possible causes for chronic cough

Chronic Cough Workup, Part II
Chronic Cough Workup, Part III


Related Topics
: Whooping Cough, COPD

Technorati Tags: asthma,allergies,GERD,COPD,cough

Posted by: Paul Enright MD at 3:18 pm

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