© Dr. Michael D. Jacobson, D.O. Do not reproduce this article without permission.
Recently, a CHM member wrote:
Dear Dr. Jacobson,
My wife has a cough she can’t get rid of. We have been to our primary doctor and it hasn’t helped. We have been missionaries for many years and have used many remedies from the region where we served. Sometimes they helped, but the cough always comes back. My wife says it’s a tickling in her throat that causes the cough. Could you offer some suggestions to help her?
Dr. Jacobson’s response:
Thank you for your question about chronic cough. It’s not an easy one to answer, particularly when the cough has persisted for years. Your letter didn’t mention any particular clues, other than the fact that you’ve served on the mission field for many years—thank you—and that the cough appears to be a “dry” cough. A chronic cough by definition is one that persists for longer than eight weeks, so your wife meets that criterion.
Some common causes of chronic cough in adults include:
- Medications, especially angiotensin-converting enzyme (ACE) inhibitors (for hypertension)
- GERD (gastroesophageal reflux disease)
- Smoking (would not be a factor for CHM members)
- Post-nasal drainage (chronic, i.e. from low grade allergy)
Less common considerations include:
- Tuberculosis (usually risk factors are clear) and other chronic infections
- Lung cancer (usually associated with other signs and symptoms)
- Cystic fibrosis
- And a host of other possibilities
A thorough history can provide important clues about the cause of the problem. Do you remember when the cough first began?
- Was it preceded by an illness—for example, a respiratory infection?
- If there was an illness, do you know what it was? How severe was it?
- Since the cough began, have you noticed anything that makes it better or worse?
- Does it persist through the night or does it occur only in waking hours?
- Is it worse at night, during the day, or about the same?
- Does the cough worsen with exertion such as exercise, etc.?
Since the problem has persisted for years, I suggest you consider a thorough evaluation by a lung specialist (pulmonologist). However, since a pulmonologist’s services might be quite expensive, you might want to first try a few other things. A conservative, low cost (initially), step-wise approach might include the following:
- Keep a diet-symptom log for at least a couple of weeks. One of my fact sheets* entitled Food Sensitivities shows you how to do this. The purpose of keeping the log is to look for any diet or environmental cause-effect associations. After each meal, jot down an abbreviated list of the foods you ate and whether any symptoms have been present since the last time you ate. Score those symptoms on a scale of zero to three. If associations are noticed, an elimination approach, explained in my Allergy fact sheet, can be attempted. (*Editor’s note: The Food Sensitivities and Allergy fact sheets are available upon request by emailing us.)
- Try a long-acting antihistamine for at least two weeks. It’s not my intention to endorse a product, but my personal over-the-counter favorite is Vicks NyQuil™ Cough. It’s best to take it at bedtime, but it can be administered (with caution because of potential drowsiness) during the day. If symptoms are dramatically reduced, then it’s likely there’s an allergy causing post-nasal drainage.
- If she still has symptoms after trying the options above it might be time to consult with the specialist.