Taming chronic cough

Chronic cough – often causing much discomfort, frustration, irritability and sleep disturbances in 10 percent to 20 percent of adults – is one of the leading reasons for consultation with a physician according to a report published this month in Annals of Allergy, Asthma & Immunology , the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI).

Matthew A. Rank, M.D., at Mayo Clinic in Rochester, Minn., and his colleagues, define a chronic cough as one lasting longer than 8 weeks in adults and 4 weeks in children.

“Coughing plays an important role in the body's defense system by clearing the airway of excess secretions and foreign bodies,” note the authors. “However, in some patients cough may be excessive and unnecessary and may lead to a general deterioration in quality of life.”

From the patient's perspective, the most prevalent problems observed in a recent survey were frustration, irritability, anger, frequent physician visits and testing, and sleep disturbances.

The three leading causes of chronic cough in adults are upper airway cough syndrome (UACS, also known as postnasal drip syndrome), asthma, and gastroesophageal reflux disease (GERD). The treatment described as the most effective cough resolution involves testing for all three conditions and treating them simultaneously.

“Unfortunately, less research is available in childhood cough when compared to their adult counterparts,” said co-author John Oppenheimer, M.D., UMDNJ-New Jersey Medical School, Cendar Knolls, N.J. “In one study bacterial bronchitis was identified as the most common explanation for chronic cough in children, while asthma, GERD and UACS comprised less than 10 percent of the diagnosis. On the other hand, in another study, asthma was found to be the most common cause of chronic cough in children, reinforcing the need for further research in identifying causes of cough in this population.”

New diagnostic techniques and treatments in development may bring faster relief to cough sufferers. Measurement of exhaled nitric oxide is shown to correlate with airway inflammation for identifying asthma. A portable Aeriflux testing system has been developed that may allow easier diagnosis of GERD-associated cough.

Taming the chronic cough requires a thorough evaluation. Considering the leading causes of chronic cough, authors note that allergists should be pivotal in its evaluation and management.

Patient information on allergic diseases including asthma is available by calling the ACAAI toll free number at (800) 842-7777 or visiting its Web site at http://www.acaai.org.

The American College of Allergy, Asthma and Immunology (ACAAI) is a professional medical organization headquartered in Arlington Heights, Ill., that promotes excellence in the practice of the subspecialty of allergy and immunology. The College, comprising more than 5,000 allergists-immunologists and related health care professionals, fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research.

Citation: MA Rank, et al. Taming chronic cough. Ann Allergy Asthma Immunol 2007;98:305-313.

Annals of Allergy, Asthma & Immunology is online at http://www.annallergy.org 

http://www.acaai.org