Chronic coughing is defined as coughing on
a daily basis for three weeks or longer. And in smokers, they cough every day and that's
a pretty common complaint. But if it's a non-smoker, coughing that lasts longer than three weeks
in duration is probably asthma, heartburn or postnasal drip. And it's interesting because
if someone does not smoke cigarettes and they have a normal chest x-ray, there are really
only three possible causes of this chronic coughing.
About 50 percent of the time it's
asthma that hasn't been diagnosed yet. So if you're just flipping a coin, 50 percent
of the time, you'll be right in treating it for asthma. But the other 50 percent are made
up of postnasal drip, which is particularly common in older folks above the age of 60,
and then the real booger in all this is the, the reflux or heartburn can cause coughing. It's
frustrating because the heartburn can be totally asymptomatic and yet the person can be coughing
because of reflux.
To get the symptom we all know and love as reflux or heartburn you need
a whole cup of acid in your esophagus or swallowing tube; to cough you only need a teaspoon full.
So, but cough chronic coughing with a normal x-ray in a non-smoker is never an infection.
So antibiotics are usually fairly useless. When we evaluate someone for chronic cough,
the first question I give them is make sure their x-rays are normal but the first question
is, are there any history of childhood asthma or allergies? Because it is so common.
there is and sometimes even if there isn't, I will initiate asthma therapy because that
will almost immediately take the coughing away in most people. If they come back and
the asthma therapy has not had any impact on their cough, then I will get the ear, nose
and throat people to look at the voice box and see if there's evidence of irritation