One of the most annoying symptoms to ruin a patient’s day is the persistent cough. It is not limited to any particular time of the year. Some cases are acute and some cases are chronic, but the hallmark is that the symptom doesn’t go away as quickly as the patient hopes. A simple cold should last no more than a week.
There are many different causes of persistent cough. First off, let’s rule out the more serious causes. Fortunately, they are far less common than the benign causes. The most important initial question is whether the patient smokes. If so, a persistent cough warrants a scope of the throat and an immediate chest x-ray to rule out cancer. Even in smokers, benign causes of persistent cough are still more common than cancer, but other lung disorders may warrant a pulmonary referral. In non-smokers, cancer is quite uncommon, but other causes of persistent cough may require immediate treatment, such as asthma, bronchitis and pneumonia. Should simple remedies fail to control the cough, a scope of the throat, a breathing test called spirometry, and a chest x-ray are still warranted.
Once the serious causes are ruled out, the more likely diagnoses can be treated. A simple cold may resolve in a week, but the post viral inflammatory response may persist for a while. A patient may feel better, but the annoying cough may continue for several weeks. In Hampton Roads, the most common cause of persistent cough is the usual suspect. That’s right. You guessed it. Allergies! In the warmer months, it’s usually pollen and outdoor molds. In the winter, it’s usually indoor allergens. The second most common cause is acid reflux, even when no heartburn is present. The third most common cause is allergies plus acid reflux together. From there, the list dwindles but includes other causes of upper airway inflammation and neurogenic cough. Frequently, chronic sinusitis needs to be ruled out.
Numerous over the counter cough preparations exist. Most include a non-sedating cough suppressant. Some include a drying agent or a decongestant. If other allergy symptoms are present, a nasal steroid spray can be used. If heartburn is present, an anti-reflux medicine can be taken. Should these simple remedies fail, an otolaryngology consult is appropriate for the workup mentioned above. Antibiotics or steroids may be necessary for sinusitis and bronchitis. Rescue inhalers may be necessary for asthma. Prescription cough medicines work better, but they are usually sedating and potentially addicting. They may be used with caution. Should the persistent cough continue, allergy testing is indicated to the find the root cause of the problem. Usually, it’s something to which the patient is exposed on a regular basis. After all, the cough is persistent for a reason.
Timothy A. Queen, MD is a board certified otolaryngologist and a fellowship trained otolaryngic allergist. He owns Advanced ENT & Allergy, in Oyster Point of Newport News. Please call 757-873-0338 for an appointment.
