Cough...cough, cough.
Sometimes it's a self-perpetuating condition.
with B. Lauren Charous, M.D., director of
the Allergy and Respiratory Care Center at Advanced Healthcare
Coughs. People suffering from colds and flu have them. Smokers have them. And, kids, who suffer from colds and respiratory viruses far more often than adults, have them often. But for those not suffering from nicotine addiction or the aftermath of a cold or flu, coughs that linger are both annoying and may be a symptom of conditions that ought to be treated.
"When you get a cough that is particularly vigorous or persists more than two weeks, you have to start asking, 'What's going on?' and see a physician," said Dr. B. Lauren Charous, a respiratory allergist with Advanced Healthcare.
Dr. Charous stressed three reasons for treating coughs. The first is that "coughs are self-perpetuating, that is the more you cough, the more you cough," Dr. Charous said.
Second, coughing can be a manifestation of other problems - nearly all of which are treatable. Ninety-five percent of coughs stem from nasal allergies, sinus disease, airway problems such as asthma, and/or GERD (gastric reflux). "Often the problems overlap. If you aren't taking care of the upper airway at the same time you are taking care of say, asthma, you won't solve the problem," the doctor said.
Finally, coughing can lead to other problems. "When you cough hard, you expel a column of air up the airway at between 300 and 500 miles an hour. It's very hard on the airway. In addition, by bearing down you increase intra-abdominal pressure which in turn causes more reflux and cough," Dr. Charous said.
Lack of sleep is a problem for some chronic coughers. Cough also causes social or work problems. Consider those who make their living on the phones, as an example. For women, a major problem can be stress incontinence. In older patients you can have fractured ribs. "This is not a benign condition," Dr. Charous stressed.
Evaluating cough's causes
Most coughs are caused by a problem in the airways. In the upper airway, a physician looks for signs of sinus infection or allergies because postnasal drip or nasal block can cause coughs. In the lower airways, a doctor will check for signs of asthma or pulmonary problems.
In older adults, the physician may visualize the vocal cords to check for vocal chord polyps or nodules. A doctor also will look for signs of GERD (gastric reflux) and take a family and personal history of a patient. This is because asthma and allergies often run in families, or a childhood problem with allergies or asthma may go away as a person ages and then return later in life.
Smoking is a common cause of chronic cough and rarely goes away until the patient ceases smoking. Other rare causes of cough include drugs commonly used to treat hypertension and cardiac irregularities. "But with coughs, the old expression applies: If you hear hoof beats don't think zebras," Dr. Charous said.
Testing for the cause of cough
While an exam and patient's history are the most valuable ways of determining the cause of a cough, physicians may order other tests, particularly if a cough does not improve when the usual suspects are eliminated.
Common tests include a baseline spirometric flow study to measure air flow through a patient's airways, skin testing for allergies and sinus imaging studies if nasal drainage is a problem. A doctor also may order a chest X-ray if a patient has not had one recently to rule out any physical irregularities in the lungs and airways, a foreign object in the lungs or any malignancy (a very rare cause of cough).
Treating the causes
Dr. Charous said it is most economical to simply treat the suspected problem and the symptoms and see if the cough goes away. Examples might be environmental controls to alleviate the irritation of allergens (such as keeping a pet out of a bedroom or using an air purifier) or treating sinus disorders with antibiotics if an infection is present and with nasal steroid sprays.
In addition, doctors also may want to prescribe a cough suppressant. "There's nothing wrong with using a narcotic suppressant for four or five days. The issue is what will you do for chronic problems. I've seen people who have been taking narcotic suppressants for months, which is not good," Dr. Charous said.
Finding the right medication or combination of medications may take awhile. And once they are working and the cough is gone, physicians must know how to taper these drugs. "This is something of an art, something for which you need experience. Knowing how and when to back off is just as important as using the right medications initially," Dr. Charous concluded.
