February 22, 2012

Chronic Cough

 My wife has a persistent cough that has gone on for several months. She appears healthy, and apart from being a little overweight and taking medication for hypertension, she has few complaints. Any suggestions?
A cough is an interesting and often troublesome symptom. Many people have an acute cough, which is most often related to an upper respiratory tract viral infection. Such “coughs” settle over a two- to three-week period and are soon forgotten. A cough, though, can be a serious symptom because of the disease of which it is indicative.
A cough can be a feature of widely disparate disorders, such as heart failure, asthma, bronchitis, chronic obstructive lung disease, allergy, or even a result of certain medications. When a cough lasts more than eight weeks, it’s classified as “chronic.”
Your wife needs to be evaluated by her physician, who will take a thorough history that covers allergies, exposure to environmental hazards, infections, and surroundings. You mention that your wife takes medication for hypertension. One group of very effective medications has the troublesome side effect of cough. This affects some 5 to 20 percent of people taking the medication. The group of medications is collectively called ACE (angiotensin-?converting enzyme) inhibitors. Many people take Omeprazole for gastroesophageal reflux; this, too, may cause a cough.
2012 1506 page28Naturally, a chest X-ray is needed to rule out serious pulmonary problems, such as a tumor or pneumonia. If the results are negative, there are some common diagnoses that account for the vast majority of persons with chronic cough.
The person who has asthma often has a chronic cough. Though wheezing and dyspnea are commonly recognized as asthma, some people manifest only a cough. To make this diagnosis in the absence of the typical symptoms will require a pulmonary function test called spirometry, and perhaps a trial of bronchodilators.
Another group of people with chronic cough has what is called postnasal drip syndrome. Thought to be secondary to sinusitis, this response to upper airway irritation often responds to antihistamines. Probably, it represents a form of allergy.
Yet another group comprises people who have gastroesophageal reflux disease (GERD). Cough associated with GERD may affect as many as 20 percent of Americans. The patient may notice heartburn worsening with lying down. Such persons are often overweight and may benefit from the proton pump inhibitors—which, in a small minority, may themselves cause cough.
There is a fourth group of people with chronic cough who do not have bronchospasm and asthma, but who have eosinophils in their sputum. These will not respond to bronchodilators, but rather to inhaled corticosteroids.
Obviously, based on all this, your wife requires a careful and methodical approach to the symptom of cough. The history and careful examination may discover the cause.
Avoidance of tobacco smoke and polluted environments, as well as motor vehicle exhaust fumes—particularly diesel fuel—will also be helpful. Be sure that the air in your home is adequately humidified, as this is helpful to the airways.
If, indeed, your wife is taking an ACE inhibitor for control of her blood pressure, a switch to another medication may be accompanied by what will seem to be an almost miraculous cure of her cough.

Send your questions to Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland, 20904. Or e-mail them to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communications with our readers. We recommend you consult with your personal physician on all matters of your health.
Allan R. Handysides, a board-certified gynecologist is the director of the health ministries department of the General Conference. Peter N. Landless, a board-certified nuclear cardiologist, is an associate director of the health ministries department of the General Conference. This article was published February 23, 2012.