Chronic coughing: Possible causes and treatment

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. If 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 from reflux.