Chronic coughing is defined as coughing ona daily basis for three weeks or longer. And in smokers, they cough every day and that’sa pretty common complaint. But if it’s a nonsmoker, coughing that lasts longer than three weeksin duration is probably asthma, heartburn or postnasal drip. And it’s interesting becauseif someone does not smoke cigarettes and they have a normal chest xray, there are reallyonly three possible causes of this chronic coughing. About 50 percent of the time it’sasthma that hasn’t been diagnosed yet. So if you’re just flipping a coin, 50 percentof the time, you’ll be right in treating it for asthma. But the other 50 percent are madeup of postnasal drip, which is particularly
common in older folks above the age of 60,and then the real booger in all this is the, the reflux or heartburn can cause coughing. It’sfrustrating because the heartburn can be totally asymptomatic and yet the person can be coughingbecause of reflux. To get the symptom we all know and love as reflux or heartburn you needa whole cup of acid in your esophagus or swallowing tube; to cough you only need a teaspoon full.So, but cough chronic coughing with a normal xray in a nonsmoker is never an infection.So antibiotics are usually fairly useless. When we evaluate someone for chronic cough,the first question I give them is make sure their xrays are normal but the first questionis, are there any history of childhood asthma
or allergies? Because it is so common. Ifthere is and sometimes even if there isn’t, I will initiate asthma therapy because thatwill almost immediately take the coughing away in most people. If they come back andthe asthma therapy has not had any impact on their cough, then I will get the ear, noseand throat people to look at the voice box and see if there’s evidence of irritationfrom reflux.
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