Chronic Cough: Common and Often Vexing

Solving the Problem Can Take Time, Doctor Notes

From the WebMD Archives

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."

Setting Expectations

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.

WebMD Health News Reviewed by Louise Chang, MD on November 02, 2005


SOURCES: American College of Chest Physicians' Chest 2005, Montreal, Oct. 29-Nov. 3, 2005. Kaiser Lim, MD, director, chronic cough clinic and asthma clinic, pulmonary division, Mayo Clinic, Rochester, Minn. News releases, Mayo Clinic.
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