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Chronic Cough: Common and Often Vexing

Solving the Problem Can Take Time, Doctor Notes
By
WebMD Health News
Reviewed by Louise Chang, MD

Nov. 2, 2005 -- Chronic cough -- coughing for three weeks or more -- affects many people and often hampers their quality of life, Mayo Clinic doctors report.

Kaiser Lim, MD, and colleagues studied patients with chronic cough at the Mayo Clinic. They found that chronic cough often touched many aspects of patients' lives, including mood, lifestyle, sleep, and relationships.

The findings were presented at Chest 2005, held in Montreal by the American College of Chest Physicians.

Common Problem

Chronic cough is "very common," Lim tells WebMD. Lim directs the chronic cough clinic and asthma clinic in the pulmonary division of the Mayo Clinic in Rochester, Minn.

Lim's team surveyed more than 130 chronic cough patients at the Mayo Clinic. The topic was how chronic cough affected the patients' quality of life.

Chronic cough bothered more than three-quarters of patients surveyed. Age, sex, and length of time with chronic cough didn't change that.

Patients' Top 4 Complaints

The surveys showed four leading complaints in patients with chronic cough:

  • Frustration, irritability, or anger (about their coughing)
  • Frequent doctor visits and testing related to their coughing
  • Sleep disturbances
  • Interference with social gatherings

A third of patients younger than 65 said their spouse or roommate had moved out of their bedroom because of the patient's coughing.

"We did this study to understand our patients," says Lim.

He says he's had patients with other troubles caused by chronic cough. "We've had women in their 70s have urinary incontinence," says Lim.

He mentions a patient who had graduated from a prestigious university and had returned to meet with her old sorority. She "ended up laughing and coughing and soiling herself. So for the rest of the meeting, she hid in the bathroom. I mean, it broke my heart," says Lim.

He also mentions a man who fainted while coughing and driving, and "woke up with the minivan in the neighbor's swimming pool. He said, 'Dr. Lim, what if I were shuttling the kids to a soccer game and this happened to me?'"

Fainting while coughing -- cough syncope -- is rare, but Lim says he sees it at least four or five times per year.

Finding and Fixing the Problem

Chronic cough can be treated. But finding the right approach may take time.

Common causes for chronic cough include asthma, postnasal drip, and gastroesophageal reflux disease (GERD), write the researchers.

Doctors rule out the suspects one by one. That can be trying for patients, Lim notes.

"The thing is, people oftentimes go through evaluation not realizing that the diagnostic approach to cough is a diagnosis of exclusion," Lim says.

"So essentially, what you do is you go through a series of diagnostic tests that is useful at excluding possibilities. So at the end of a $64,000 work-up, people can tell you what you don't have. But they can't tell you what you have. Hence, the frustration," he continues.

"The second thing is that even if you find an abnormality, it doesn't mean that that abnormality is the 'a-ha' effect," says Lim. "You still have to treat that abnormality, and when that abnormality resolves and the cough resolves in parallel can you actually say that A causes B."

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