Cough is one of the most common complaints we hear. In fact, it’s estimated to account for 4% of adult visits to doctors, of 25 million visits a year. The annual cost of treating cough in the U.S. is estimated to exceed $1 billion!

Acute cough is any cough that lasts less than 3 weeks. It’s usually caused by a viral illness, such as a cold. Lots of other things can be responsible:

sinusitis

allergy (post-nasal drip)

asthma

acute bronchitis

pertussis (whooping cough)

More rarely:

pneumonia

congestive heart failure (see April 2001 newsletter)

pulmonary embolus (a clot that travels to lung arteries)

Chronic cough lasts 3 weeks or more. Major causes include:

post-nasal drip (40-50%)

asthma (25-30%)

GERD - GastroEsophageal Reflux Disease - or heartburn (20-25%)

And there are less frequent causes:

chronic bronchitis

                    bronchiectasis (thinning and consolidation of air sacs such as from cystic fibrosis or smoking)

                    post-infectious cough - such as the one that lingers from whooping ("100 day") cough, more common now due to waning immunity from the childhood vaccine.

                    tumors: lung & other cancers

                    medications, such as angio-tensin converting enzyme inhibitors (ACEI’s): captopril (Capoten), enalopril (Vasotec) and others.

Post-Nasal Drip is far and away the most common cause of cough. There are 3 major issues:

                Allergic drip: profuse watery discharge can be seen with seasonal (acute) allergy - and can lead to "choke cough" when lying down. It can also be seen with perennial allergy - which is frequently obscure because there’s no itch, sneeze or runny nose.

                Non-allergic drip can come from chronic extra blood flow in the nose and sinuses; these patients also are more likely to have upper airway and bronchial spasm.

                Chronic sinusitis will also cause cough: such patients will have excess sputum with their cough.

Rare causes include:

                Chronic Interstitial Lung Diseases which are often tough to diagnose.

                Habit (nervous) cough

Asthma is frequently due to allergy, and is often triggered by mouth breathing (which is seen in those who can’t nose breathe). Cough can be the only symptom (cough variant or "hidden" asthma). Post-nasal drip can trigger asthma; but some patients seem susceptible to both.

GERD (Heartburn) is due to acid "leaking" up form the stomach, which is protected from it, into the esophagus, which is not. 10-20% of GERD patients have respiratory symptoms including cough. These occur due to a nerve reflex from the esophagus to the airway or due to "microaspiration" of acid into the lung. Most patients with GERD cough do not have heartburn symptoms!

Diagnosis and Treatment are directed at the cause (or causes!) of the cough, sometimes treating the major causes simultaneously: sprays and antihistamines (and perhaps antibiotics) for the nose, inhalers and other drugs for asthma, allergy avoidance (or allergy shots), and acid blockers for the GERD. If therapy is unsuccessful, other tests, such as X-rays and CT scans, are done.

•  Less than 1 week
• 1-2 weeks  
• 2-4 weeks 
• Over 4 weeks

            2. How many times a day do you cough?

• 1-5
• 6-10
• 11-20
• Over 20 times

            3. Is your cough productive? In other words, do you bring up mucus or phlegm

(a thick, slimy substance)?

• Yes
• No

• Yes
• No

If yes," when do you usually have this feeling?

• At night
• After/during exercise
• Early morning

5. Is your cough seasonal?

• Yes
• No

If "yes," which season is the worst?

• Spring
• Summer
• Fall
• Winter

6. Have you had a cough like this before? If "yes," how long did it last?

• Weeks (how many?)____________
• Months (how many?)___________

• Yes
• No

           8. Do you live with anyone who smokes?

• Yes
• No

           9. Do you have pets

• Yes
• No

        If so, what kind?__________________________________________________

        10. Do you have any allergies?

• Yes
• No

• Yes
• No

        12.Is there one area where your cough is the worst?

• Yes
• No

• Home
• Work
• School
• Other________________________________________________

13.Do you have "heartburn" or "indigestion?"

• Yes
• No
• Seldom

If "yes," when is this most common?

• Night
• After meals
• No special time

14.Are you taking any medications (prescription or over-the-counter)?

• Yes
• No