Chronic Cough is a Gender Issue

Did you know that the debilitating medical condition of Chronic Cough is a gender issue?  Chronic Cough is not gender neutral.  In fact, Chronic Cough favors women.  While Chronic Cough does affect both men and women, just being a woman sets you up for Chronic Cough.  Chronic Cough affects women more often than men.  And it particularly affects women as they age.   Dr. Mandel Sher’s vast experience diagnosing people who suffer with Chronic Cough and recommending cough treatment confirms the higher incidence of Chronic Cough among women.

“Chronic Cough as a Female Gender Issue,” a review article by Kavalcikova-Bogdanova, Buday, Plevkova, and Song published in the January 9, 2016 issue of Advances in Experimental Medicine and Biology, addresses this phenomenon.  The authors suggest the role of hormones in excessive cough.

According to Dr. Sher, women are hard-wired to cough.  That means that women organically have a more sensitive cough mechanism.  The higher sensitivity of the cough mechanism means that it takes a lower level of irritants or stimuli to trigger coughing spells.  And since cough begets cough, Chronic Cough can become the result.

Dr. Sher emphasizes that cough is an important mechanism in all children and adults.  But in 12 to 15% of the population, a persistent cough that won’t go away becomes disruptive.  Chronic Cough has negative physical, mental, professional and social consequences.  Dr. Sher goes on to say that the goal of cough treatment is to normalize cough – not to suppress cough. 

Sometimes, cough is an indication of a more serious underlying medical condition.  In people suffering with Chronic Cough, cough is often THE problem.  A lingering cough is not normal and should not be ignored.  If you or someone you love has a Chronic Cough, contact Dr. Mandel Sher at Center for Cough:  727-393-8067.

Depression and Chronic Cough

Chronic Cough is not gender neutral.  While Chronic Cough affects men and women, it affects women more often; particularly middle-aged and older women.  Chronic Cough is a debilitating medical condition with physical, mental, social, and professional consequences.  Social isolation and depression are often associated with Chronic Cough.

If you or someone you know has persistent cough and symptoms of depression, contact Dr. Mandel Sher at Center for Cough:  727-393-8067.

“Prevalence of Depressive Symptoms Among Patients With Chronic Cough”  by Dicpinigatis, Tso, and Banauch, published in the December 2006 issue of Chest, reported that over fifty percent of patients with chronic cough were clinically depressed. The authors pointed-out that physicians and others should be aware of the association between chronic cough and depression and recognize depression symptoms. Patients who were treated and experienced decreased cough also experienced a decrease in depression according to the authors.

Persistent cough is not normal.  A cough lasting more than eight weeks should be evaluated by a Cough Doctor to identify the cause and develop a comprehensive cough treatment plan.  Sometimes, cough is a symptom of a serious underlying medical problem.  Sometimes, cough is THE problem.  Chronic Cough can be successfully treated even in patients who have seen other doctors and failed other cough treatments.

Dr. Mandel Sher Presents Advanced Diagnostic Tool to National Physician Audience

Dr. Mandel Sher recently presented a seminar on Rhinolaryngoscopy  at the American Academy of Allergy, Asthma & Immunology in Los Angeles, California. Rhinolaryngoscopy is an advanced diagnostic tool used to identify the underlying cause of Chronic Cough.  Dr. Mandel Sher is specially trained in Rhinolaryngoscopy and one of the few doctors in the Tampa Bay area who uses rhinolaryngoscopy in the office to make a firm diagnosis of Chronic Cough or Upper Airway Disease. 

Rhinolaryngoscopy is in invaluable diagnostic tool for identifying the triggers and causes of chronic cough and upper airway disease” stated Dr. Sher.  Dr. Sher has performed thousands of rhinoscopies in Center for Cough and regularly teaches other physicians how to perform rhinolaryngoscopy.  Endoscopy or rhinolaryngoscopy of the nasal and sinus structures, back of throat and the voicebox (larynx and vocal cords) is an advanced diagnostic tool that enables Dr. Sher to clearly see sinusitis, allergic rhinitis, nasal polyps, deviated septum, infected or enlarged adenoids, layrngopharyngeal reflux (stomach acid attacking the voice box), vocal cord nodules and polyps, and “dancing” vocal cords – a sign of neurogenic cause of chronic cough. 

This simple and relatively non-invasive procedure is a cornerstone of the diagnostic approach used by the Center for Cough.  Diagnostic precision of underlying cause of Chronic Cough is the first step to Dr. Sher developing an effective cough treatment plan for each patient. 

Dr. Sher and his colleague, Dr. Gary Stadtmauer of CityAllergy in New York, New York collaborated on this program. 

Yankees’ Teixeira’s Problem: Damaged vocal cords

New York Yankees Mark Teixeira was suffering with a lingering cough.  He had seen doctors to have his cough evaluated, but it wasn’t until he saw a doctor who used a rhinoscope, an advanced diagnostic tool,  that a diagnosis of damaged vocal cords was made.  Dr. Mandel Sher at Center for Cough is specially trained in the use of rhinoscope and is one of the very few doctors in the Tampa Bay area offering this test. A rhinoscope is a thin tube-like instrument with a light to examine the inside of the nose.

Contact Dr. Sher to schedule a comprehensive cough evaluation that will yield a precise diagnosis and result in a cough treatment plan:  727-393-8067.

“When you have damaged vocal cords,” the doctor told  Teixeira, “you’re always having a cough-gag reflex. So it’s actually really good news for me because we think we’ve found the reason for all this.”

“She gave me some medicine that will hopefully calm the nerve down. It kind of puts my mind at ease” said Mark Teixeira.

“In other words, some of his more severe coughing fits triggered the damage.” continued the ear, nose, and throat doctor.

“That’s why all of my blood tests were clear, that’s why my chest X-rays were clear,” said Teixeira, who had seen several doctors, including a chest specialist in mid-May who diagnosed him with “inflamed bronchial airways”

Why Does Hillary Clinton Keep Coughing?

Secretary Clinton is coughing again.  Regardless of your political persuasion, observers are wondering, “Why Does Hillary Clinton Keep Coughing?” While Dr. Mandel Sher at Center for Cough has not evaluated Secretary Clinton, he believes there is a high likelihood that Mrs. Clinton has Chronic Cough.  Mrs. Clinton fits the profile of a typical Chronic Cough patient.  Chronic Cough affects men and women, but it affects women, particularly as they age, more often.  In the absence of a precise diagnosis and rationale for coughing spells, there is speculation and worry.

Dr. Mandel Sher, Medical Director at Center for Cough, is a Cough specialist.  Dr. Sher encourages people who are suffering with a persistent cough that won’t go away to come-in for a cough evaluation and cough treatment plan.  Dr. Sher emphasizes that sometimes Chronic Cough is a symptom of an underlying and more serious medical problem.  Sometimes, Chronic Cough is THE problem!  In all cases, lingering cough should not be ignored and people suffering with Chronic Cough should not learn to live with it.

…“It’s not just cough,” Secretary Clinton’s doctor said. “There’s some hoarseness, there’s some throat clearing, in fact there’s frequent throat clearing. When you have these trio of symptoms, you have to think of what I call throat burn reflux, which is acid reflux affecting the throat…”

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Center for Cough President Obama's acid reflux

President Obama’s Cough Associated with Acid Reflux

Did you know that sore throat and cough may be symptoms of acid reflux?  And did you also know that acid reflux may be a trigger of Chronic Cough?  Thanks to President Obama’s brief health scare in December 2014, more people may now recognize these symptoms and their role as an underlying medical condition that produces Chronic Cough.

“The president’s symptoms are consistent with soft tissue inflammation related to acid reflux and will be treated accordingly” according to Dr. Jackson.  Dr. Jackson said he ordered the CT scan, which is not routine for patients with these symptoms because he felt it was the “next prudent step,” said the White House press secretary, Josh Earnest. He said that Dr. Jackson’s diagnosis “was complete…”  According to the Washington Post and other news organizations, President Obama’s symptoms included a sore throat and cough.

Dr. Mandel Sher In North Carolina: New Concepts in Chronic Cough

Dr. Sher in North Carolina: Emerging Concepts in Chronic Cough “New Concepts in Chronic Cough”  presented by Dr. Sher to his North Carolina colleagues was just the invitation he needed to return to beautiful North Carolina.  Dr. Sher began his specialty training at Duke Health System in Durham, North Carolina, after graduating from Northwestern University’s medical school in Chicago, Illinois.  The scientific and medical community’s understanding of Chronic Cough causes and treatments are evolving rapidly and it was Dr. Sher’s pleasure to share these new concepts.     

Mandel Sher, MD, Medical Director of Center for Cough, spoke to the North Carolina Allergy, Asthma and Immunology Society’s annual meeting on Saturday, February 6, 2016 on “New Concepts in Chronic Cough”.  Dr. Sher is one of the nation’s leading investigators studying new scientific and clinical findings about the causes of Chronic Cough and effective cough treatments.  These new concepts in Chronic Cough have the promise of expanding our understanding of this debilitating medical condition and treating it effectively.

Chronic cough affects 12 to 15% of the population and has debilitating consequences:  Depression, Social Isolation, Fatigue, and Urinary Incontinence to name a few.  Dr. Sher spoke about the current unmet need in cough treatment and the promising cough treatments in the future.  Dr. Sher addressed the paradigm shift in the diagnostic and cough treatment approach to now focus on overly sensitive cough mechanism particularly in people who are hard-wired to cough. 

“The hypersensitive cough reflex is the primary cause of chronic cough triggered by multiple factors including viral respiratory infections, allergies, asthma and acid reflux”, Dr Sher told the group of North Carolina allergists.”




Can Talking be Contributing to your Chronic Cough?

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Can talking be contributing to your Chronic Cough?  Yes!  Talking by someone who has an overly sensitive cough mechanism can result in coughing fits.  The act of talking dries the throat and the dry throat acts as an irritant to the cough mechanism. So, it may not be surprising that Presidential Candidate Hillary Clinton experienced an “uncontrollable coughing fit” while speaking in Hanoi in 2012.  The coughing episode resulted in Mrs. Clinton concluding her remarks early.

Chronic Cough can diminish professional performance.  Physical fatigue and anxiety associated with cough occurring at an inopportune time can be distracting.  Chronic Cough can also cause colleagues to avoid working with you for fear that you are sick and contagious.

Sometimes, cough is an indication of an underlying and significant medical problem.  Sometimes, Chronic Cough is THE problem.  Dr. Mandel Sher, Medical Director and Founder of Center for Cough, is a Cough Doctor.  He understands the debilitating consequences of Chronic Cough.  A comprehensive diagnostic and cough treatment approach results in precise identification of your cough cause(s) and cough treatment that will be effective.

If you or someone you know is suffering with Chronic Cough, contact Dr. Mandel Sher:  727-393-8067.


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Positive Results in Chronic Cough Trial

Afferent Pharmaceuticals Announces Positive Results in Phase 2b Chronic Cough Trial

AF-219 Treatment Significantly Reduces Cough Frequency in Patients

SAN MATEO, Calif.–(BUSINESS WIRE)–Afferent Pharmaceuticals, a leader in the development of small molecule compounds targeting P2X3 for the treatment of poorly managed and common neurogenic disorders, such as chronic cough, today announced positive top-line results from its Phase 2b dose escalation clinical trial of AF-219 in chronic cough patients. AF-219 is a selective, non-narcotic and orally administered P2X3 antagonist that targets the mechanism by which certain nerve fibers become hyper-sensitized and can lead to chronic and debilitating symptoms. The results of this clinical trial will be presented at a scientific meeting in the future.

“Our promising Phase 2b results demonstrate AF-219’s potential to be a first-in-class therapy, with the potential to replace the current, often ad hoc treatments that have little impact on cough frequency or result in possibly serious side effects or carry abuse potential,” said Kathleen Sereda Glaub, Afferent’s chief executive officer. “With the robust reductions in cough frequency following AF-219 treatment confirmed in this second study, we are committed to a full development program to advance this non-narcotic treatment for the benefit of the many patients suffering from chronic cough.”

Jaclyn Smith, M.B., Ch.B., MRCP, Ph.D. and professor and honorary consultant in Respiratory Medicine, University of Manchester and University Hospital Manchester NHS Foundation Trust, a leading investigator in the field of chronic cough, said “Chronic cough has widespread effects on patients’ quality of life, and a new therapy with increased efficacy and substantially reduced adverse events will have a meaningful impact and address a significant unmet need. I am excited by the consistency of the findings demonstrated in the AF-219 program, and I look forward to the continuing progress of these efforts.”

Significant Efficacy and Improved Tolerability Shown With Lower Doses

The study randomized 29 chronic cough patients. Doses of 50 mg, 100 mg, 150 mg and 200 mg twice daily for 4 days demonstrated significant reduction in cough frequency, including at the lowest dose of 50 mg twice daily. Cough frequency was measured objectively utilizing a cough recording device, with periodic measurements following AF-219 treatment compared to a baseline recording.

All AF-219 doses, including the lowest dose of 50 mg twice daily, demonstrated a statistically significant reduction in awake cough frequency compared to placebo (p≤0.002).

AF-219 was generally well tolerated. The incidence of decreased taste acuity, as observed in the first study at 600 mg twice daily, was much less at the 50 mg dose. Only one patient discontinued treatment at any dose in the current study, due to the taste effect.

Afferent’s previous high-dose proof-of-concept trial demonstrated a 75% reduction in cough frequency (Intent-to-Treat population) in 24 refractory chronic cough patients with AF-219 treatment 600 mg twice daily for two weeks. In the first study, six of 24 patients discontinued treatment due to a change in taste acuity (published in the Lancet, March 2015; online November 2014).

About the Phase 2b Trial

The 29-patient randomized, double-blind, placebo controlled, Phase 2b crossover study was conducted at 10 clinical sites in the U.S. Patients were randomized to either AF-219 or placebo arms. Those in the treatment group received AF-219 50 mg, followed by a titration up to 100 mg, 150 mg and 200 mg, with each dose given twice daily for four days. Treatment period one was followed by a 3-5 day washout period. Patients were then crossed over to the alternate arm of the study and treated with either AF-219 or placebo for 16 more days.

Pathologic Cough – Debilitating & Potentially Chronic Neurogenic Disorder Affecting Millions

Cough is the symptom for which patients most often seek medical attention. Pathologic cough or non-productive cough serves no functional purpose, and can occur following an upper respiratory infection. In most patients, this cough manifests itself as an acute cough lasting a few weeks. However, in some patients, sensitized nerve fibers fail to return to a normal quiescent state, resulting in sub-acute or chronic cough lasting months to years. The prevalence of chronic cough is estimated to be over 10% of adults in the U.S. While an underlying etiology may contribute to cough in some of these patients (such as GERD, asthma, COPD, etc.), many patients are not well-controlled for their cough even with treatment for such underlying etiology, or with the addition of currently available cough medications.

P2X3 Receptors Role in Hyper-sensitization and Pathology

The P2X3 receptor, the target for Afferent’s lead AF-219, is predominantly expressed in nociceptive C-fiber primary afferent nerves that innervate most tissues and organs, including the skin, joints, and the hollow organs such as the airways and bladder. These primary afferent neurons are not important in normal physiological or defensive sensing processes, but rather become activated and sensitized under pathological conditions by a common cellular signal, ATP, such as following nerve injury, infection or inflammation.

P2X3 receptor-mediated sensitization has been implicated in inflammatory, visceral and neuropathic pain states, as well as airways hyper-reactivity, migraine, itch and cancer pain.

Afferent’s first-in-class compounds selectively target P2X3 channels in order to block the activation of these afferents by ATP.

About Afferent Pharmaceuticals

Afferent Pharmaceuticals is a clinical-stage biotechnology company and leader in the development of novel drugs for the treatment of a range of debilitating neurogenic disorders. These disorders affect millions of patients who suffer from chronic respiratory and urologic sensory pathologies as well as chronic pain and cardiovascular disorders, and who have limited, if any, treatment options. These chronic pathologies arise when certain nerve fibers become hyper-sensitized as a result of inflammation, distress, infection or tissue injury, and sometimes remain chronically sensitized for months and even years.

Afferent is developing molecules that selectively block P2X3, a purinergic receptor, which plays a key role in the sensitization of these nerves. Afferent’s lead molecule, AF-219, is a first-in-class P2X3 antagonist, and is being developed for the treatment of chronic cough. For more information on the company, please visit Afferent’s website


Afferent Pharmaceuticals Amy Pfeiffer, 650-286-1276 or Media: Burns McClellan, Inc. Justin Jackson, 212-213-0006, Ext. 327


What’s Causing You to Cough?

We all cough.  Cough is an important function.  But like many things, too much of a good thing is no good.  The first and most important step toward effective cough treatment is understanding what’s causing cough.  And there’s a meaningful difference between identifying the underlying cause of your cough and the triggers or irritants or stimuli that tickle your body’s cough mechanism and produce  cough.  Real and lasting success relies on addressing what’s causing cough rather than the symptom.

Dr. Mandel Sher and Center for Cough team accurately diagnose the cause and triggers of your unique cough. Accurate diagnosis is the foundation of an individualized and effective cough treatment plan.

Cough evaluation includes a thorough medical history and physical exam exploring your cough symptoms and their effects on your daily activities. Previous physician visits, laboratory testing, X-rays, and diagnostic procedures will be reviewed. Based on this evaluation, further testing may be performed at the initial visit using advanced diagnostic tools. These tools include:

  • Rhinolaryngoscopy
  • Pulmonary function studies
  • Pulmonary inflammatory testing (expired nitric oxide)
  • Allergy testing
  • Oropharyngeal pH (acid) probe

Precision cough diagnosis avoids a trial and error approach with cough treatments that prove to be ineffective.  Accurate diagnosis and targeted cough treatment also shortens the time it takes for people suffering with Chronic Cough to feel better.  More than 8 out of 10 Center for Cough patients demonstrate measurable improvement in their cough and life. 

Dr. Sher is a Cough Specialist.  He is the only doctor in the southeastern United States, and one of only a few in the nation, who focuses on being a cough doctor.  Dr. Sher and Center for Cough team have a comprehensive approach to cough diagnosis and cough treatment.  In almost all cases, cough evaluation and recommendation of cough treatment occurs during a single outpatient visit to the Center for Cough  office.

If you or someone you know suffers with Chronic Cough, contact Dr. Mandel Sher at Center for Cough: 727-393-8067.