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Chronic Coughing - Ambiguities/Help
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Chronic Coughing - Ambiguities/Help

My wife has suffered with a chronic cough for more than 25 years.  We have seen a countless number of doctors and have received varying diagnosis from them all.  None of them are conclusive and their solutions did not stop her coughing.  Patch testing revealed without a doubt she has allergies. She took weekly serum shots for years and they offered some relief. However, she has now settled on OTC antihistamines. But, the coughing remains. Through the years, a few doctors have told her she also has “borderline” Asthma while another says she doesn’t.  One told her she has Reactive Airway Disease. Another doctor she has GERD, while another said she doesn’t.  She also suffers from sinus infections during pollen seasons that complicate the coughing even more. Our family doctor prescribes antibiotics for this. They help, but we all know the negatives of too many and frequent antibiotics.    

We have chased this coughing monster for all of these years and have gotten nowhere.  Accepting a chronic cough that generates 100-200 coughs each and every day is taking a tremendous toll on her.

Given these ambiguities from the medical profession and failed medications we are wearing down, very frustrated, consequently lost and are near giving up. We are in desperate need to have her seen by a staff of doctors all working together to discover her causing complications and put it all together in a specific targeted program to hopefully provide permanent relief.  Where can we go for such?      
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How dreadful for you and your wife.  Finding the cause(s) of chronic cough can be perplexing even for experts in this field but, with the advent of formal cough clinics,  the rate of success has increased significantly in recent years.  The best known of these is that directed by Dr. Richard Irwin and associates at the University of Massachusetts Medical Center in Worcester, Mass.  But there are other high quality centers including the Mayo Clinic in Rochester Minnesota, the University of Michigan Medical Center at Ann Arbor, Michigan, and National Jewish Health (formerly National Jewish Medical and Research Center) in Denver, Colorado (disclaimer, I am a member of the Medical Staff at this institution).

There may be honest differences of opinion regarding the role of Asthma and GERD as causes of chronic cough but, even so, a trial of optimum therapy for each would not be unreasonable.  Occult lung disease, often not evident on plain Chest X-rays but revealed by High Resolution CT Scanning, is yet another cause.  And, finally, when all other causes have been excluded, do not dismiss the possibility of psychogenic (habit) cough, or neurogenic cough secondary to the establishment, over time, of hyperactive cough nerve pathways.

You and your wife may find the following abstract of an article in a Medical Journal of interest:

Chronic ‘cough hypersensitivity syndrome’: A more precise label for chronic cough
K.F. Chung*
National Heart & Lung Institute, Imperial College, Dovehouse St, London SW3 6LY, UK
a r t i c l e i n f o
Article history:
Received 23 November 2010
Received in revised form
11 January 2011
Accepted 24 January 2011
Keywords:
Cough
Chronic cough
Sensitised cough reflex
Chronic cough hypersensitive syndrome

a b s t r a c t
Chronic cough remains a challenge to many clinicians because there is often no diagnostic link to causation, and because indirect antitussives are largely ineffective. Chronic cough can also be a predominant symptom associated with many chronic respiratory diseases such as COPD, asthma and pulmonary fibrosis. Chronic cough itself does impair the quality of life and is associated with psychological impairment. The symptoms associated with chronic cough include persistent tickling or irritating
sensation in the chest or throat, hoarse voice, dysphonia or vocal cord dysfunction. Currently, the clinical diagnosis of cough is associated with chronic cough caused by airway eosinophilic conditions such as asthma, gastrooesophageal reflux disease or post-nasal drip (or upper airway syndrome), which implies cause and effect, or with chronic cough associated with other diseases such as COPD, cancer or heart failure, that does not necessarily imply cause and effect. A recently-recognised category is idiopathic
cough, with no associated or causative diagnosis. We suggest that there is a better label needed for chronic cough, that includes the common association with a hypersensitive cough response to tussive stimuli such as capsaicin or citric acid. This would invoke a hypersensitive syndrome, and there are good reasons to use a new label that would encompass the problem of chronic cough: the chronic ‘cough hypersensitivity syndrome’. This would focus the problem on the cough symptomatology and lead to greater focus on understanding the mechanisms of cough sensitisation, with the ultimate aim of obtaining more effective antitussives.
_ 2011 Elsevier Ltd. All rights
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