People with chronic cough are often depressed

More than half of people with chronic cough-a nagging cough that can last for months or even years-suffer from depressive symptoms, according to a study to be presented at the American Thoracic Society International Conference on May 23.

The study of 100 people with chronic cough that had lasted an average of 9 years found that 53% suffered from depressive symptoms. The percentage of men and women with chronic cough who suffered from depressive symptoms was similar, according to study author Peter V. Dicpinigaitis, M.D., Director of the Montefiore Cough Center in the Bronx, NY.

Three months after the initial study, researchers have so far conducted a follow-up with two-thirds of the patients and found that those whose cough had improved had significant reduction in depressive symptoms, while those whose cough did not improve did not have any corresponding improvement in their depressive symptoms.

"A lot of people don't realize that cough is the single most common complaint for which patients seek medical attention in the U.S.," said Dr. Dicpinigaitis, who is also Professor of Clinical Medicine at Albert Einstein College of Medicine and Director of the ICU at Montefiore Medical Center. "This is the first study to look at the link between cough and depression."

Dr. Dicpinigaitis has seen more than 300 chronic cough patients in his practice, and was struck by how their cough has affected their quality of life. "They are socially isolated and miserable. They are afraid to go out in public, go to church or to a restaurant. Their cough affects their relationship and their jobs," he said. "Since cough doesn't kill people it doesn't get the attention that other conditions get, but it is a tremendous quality of life issue."

Chronic cough has three main causes, either alone or in combination, Dr. Dicpinigaitis said: post-nasal drip, asthma and gastroesophageal reflux (GERD), commonly known as acid reflux. "Often the diagnosis is difficult because in many patients, cough is their only symptom."

Treatments include older antihistamines combined with decongestant for cough from post-nasal drip; asthma medicines for asthmatic cough; and high doses of drugs called proton-pump inhibitors for several months, sometimes combined with other drugs, for GERD-related cough.

By the time patients have come to see him, they generally have already seen several other doctors and have been told they simply have to live with the cough, Dr. Dicpinigaitis said. "My message for patients with chronic cough is, 'Don't give up,'" he said. "Continue to seek out help. Once the cause of the cough is diagnosed, it can be treated." He noted that treatment guidelines for chronic cough will be published later this year for physicians, and he is hopeful that this will improve the treatment of the problem.

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