Chronic Cough: Common and Often Vexing
Solving the Problem Can Take Time, Doctor Notes
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."
Lim advises patients to understand that finding a solution may take time. He suggests that patients find a nearby doctor since repeated appointments will likely be needed.
"It's just the nature of the diagnostic process. It's not that the doctor isn't doing his best," he says.
Lim adds that doctors should quickly be able to rule out the conditions patients fear most, like cancer.
Patients should "work with somebody they trust, who's accessible [and] willing to see them back," says Lim. "You need somebody who's interested in the subject, interested in people."
Doctors should give patients start-and-stop dates for each approach they try, says Lim.
Scanning the Sinuses
Lim and colleagues also checked CT sinus scans of 132 chronic cough patients.
Those patients had already failed treatment for rhinitis, reflux, and asthma. Nearly three-quarters of patients who were clinically suspected of having a sinus problem had abnormal CT sinus scans, and about a third had acute sinusitis, the researchers report.
The researchers aren't recommending CT scans for most people with chronic cough. The patients they scanned had already tried other approaches. Having a history of sinus problems or sinus surgery may also push sinus problems higher on the list of possibilities, says Lim.