…But Why am I Coughing and They’re Not?

“There’s something happening here.  But what it is ain’t exactly clear,” sang Buffalo Springfield in 1966.  And so it is with an evolving understanding of what causes some people to have Chronic Cough and others not.

Asthma, gastroesophogeal reflux (GERD), and postnasal drip are commonly considered to be the major causes of Chronic Cough.  Then, why do the majority of patients with these 3 conditions NOT report coughing excessively? Something else is going on…

It’s Cough Hypersensitivity Syndrome!  People who have Cough Hypersensitivity Syndrome are hard-wired and hot-wired to cough.  It is the presence of this underlying condition in some people that causes asthma, GERD, and postnasal drip to act as triggers that produce cough.

Dr. Sher’s esteemed cough colleagues, Doctors Jaclyn A. Smith and Ashley Woodcock of the University of Manchester in the United Kingdom, addressed this paradox in “Chronic Cough” in The New England Journal of Medicine.   

The authors report:  ” An alternative theory is that an abnormality of the neuronal pathways controlling cough is likely to be the primary disorder in these patients, with identified causes (including asthma, reflux, and postnasal drip) acting as triggers only in the context of neuronal cough hyperresponsiveness.”

In other words, this medical paradox can be explained this way:    Abnormalities in the nervous system are the primary and underlying reason for some people having Chronic Cough.  These abnormalities create an environment for conditions such as asthma, GERD, and postnasal drip to act as irritants that trigger Chronic Cough.   These 3 common conditions and others act as Chronic Cough triggers when Cough Hypersensitivity Syndrome is present.  The illustration of “Neuronal Pathways Controlling Cough…” presented here comes directly from the NEJM article cited.

Cough Hypersensitivity Syndrome is the underlying cause of Chronic Cough. When it is present, common conditions such as asthma, GERD, and postnasal drip can result in Chronic Cough.

Cough Hypersensitivity Syndrome is the underlying cause of Chronic Cough. When it is present, common conditions such as asthma, GERD, and postnasal drip can result in Chronic Cough.

Dr. Mandel Sher of Center for Cough coaches cough patients on the difference between cough causes and cough triggers.  Very often, there is more than one cause and one trigger of Chronic Cough.  In fact, one of Dr. Sher’s patients refers to her cough as being “trigger happy.”

A comprehensive cough treatment approach begins with precisely identifying the underlying cause(s) and trigger(s) of each unique cough.  Dr. Sher will have an effective and lasting solution to your cough. Treat your cough cause(s) and cough trigger(s)!

Over 8 out of 10 Center for Cough patients demonstrate a measurable reduction in cough frequency.  Many of Dr. Sher’s patients have seen other doctors for their cough and tried other cough treatment that have failed.  Call Dr. Mandel Sher to learn how he can help you:  727-393-8067.

What’s in a Name? Don’t be Confused: Chronic Cough by Any Other Name is Still Chronic Cough

A Cough by any other Name would still be a Cough

A Cough by any other Name would still be a Cough

“What’s in a name?” asked William Shakespeare in Romeo and Juliet.  And just as it is with a rose,  Chronic Cough can be referred to by other names, all of them mouthfuls:  Refractory Cough, Idiopathic Cough, or Unexplained Cough.  But, don’t be confused – it could still be Chronic Cough.

If you are coughing for eight (8) weeks or longer or have already seen a physician for your cough but are still coughing, then call Dr. Mandel Sher at Center for Cough now:  727-393-8067. 

Chronic Cough refers to anyone who is coughing for eight (8) weeks or longer.  Many coughers  continue to cough despite a medical work-up for conditions  such as post nasal drip, asthma, or GERD. The medical community refers to people who have Chronic Cough that persists in spite of medical intervention as:

  • Refractory Chronic Cough
  • Idiopathic Chronic Cough
  • Unexplained Chronic Cough

Different words for the same thing can be very confusing, slow down or get-in-the-way of  productive idea sharing, and create ambiguity.  Common vocabulary within the medical community is very important for “getting on the same page” and communicating about clinical practice guidelines, data collection, research, and education.

What’s going on in chronic coughers who are refractory/idiopathic/unexplained?  These coughers are almost always “hot wired” to cough.  Simply put, these coughers have the nerve endings at the back of the throat become easily stimulated and irritated resulting persistent, annoying and frequently debilitating coughing.

Common language and shared understanding are essential ingredients for creating a Chronic Cough Community.  The development of universal terms will be challenging, but the discussions are already underway.

Dr. Mandel Sher is leading a national conversation among doctors, scientists, and patients about Chronic Cough.  Please help Dr. Sher increase awareness of and advocacy for Chronic Cough treatment by visiting the Center for Cough website and Like and Share the Center for Cough facebook page.



Is it Bronchitis or Chronic Cough?

Is Bronchitis Causing Your Chronic Cough?

Is Bronchitis Causing Your Chronic Cough?

Cough is the most frequent illness-related reason people visit their doctor.  Bronchitis is one of the main reasons why people cough.    But in most people with Chronic Cough, it is not the cause.  Most people suffering with Chronic Cough have a cough mechanism that is overly sensitive, also known as hypersensitive, making them hard-wired to cough.  Irritants trigger a hypersensitive cough mechanism to  produce cough that won’t go away.

Bronchitis refers to inflammation of the bronchial tubes.  According to Medscape, the most common signs and symptoms are cough and mucus that last for three weeks or less.   Other symptoms can include: sore throat, headache, muscle aches, and fatigue.   Chronic Bronchitis is defined as cough with sputum expectoration for at least 3 months a year during a period of 2 consecutive years.  Infectious agents, such as viruses or bacteria, and noninfectious agents, such as smoking, dust, or chemical pollutants, can be bronchitis triggers.  A flu vaccine can help reduce the risk of upper respiratory tract infections and subsequently, reduce the risk of developing acute bacterial bronchitis.

Do these signs and symptoms sound familiar?  While a Bronchitis diagnosis should be considered, other conditions such as Allergies, Asthma, Sinusitis, and Pneumonia often present a similar clinical picture.  In fact, Asthma can be mistakenly diagnosed as Acute Bronchitis.  In one study, one third of patients who had recurrent bouts of acute bronchitis were eventually identified as having asthma. Generally, bronchitis is a diagnosis made by exclusion of other conditions. 

Nagging, constant cough should not be ignored.  If you have already seen a physician for your cough and are still coughing or if you have been coughing for eight weeks or longer, make an appointment to see Dr. Mandel Sher at Center for Cough: 727-393-8067.

Cough Drops Can Work: Take the Guesswork Out of Treatment

Cough drops can really work!  Dr. Mandel Sher generally recommends cough drops as part of a comprehensive cough treatment approach.

A precise diagnosis of your cough’s cause(s) and trigger(s) is the first step toward effective cough treatment and relief.  Take the guesswork out of cough treatment by seeing Dr. Mandel Sher at Center for Cough.  Trying cough remedies that are not targeted to your unique cough wastes time and money and exposes you to unnecessary health risks and side effects.

Here’s why cough drops work:

  • Sweetness has been shown to reduce cough
  • The act of swallowing reduces cough
  • Menthol in cough drops reduces cough except in people with Chronic Cough. Menthol acts as a local anesthetic agent which temporarily “numbs” the nerves in the throat to provide relief.
  • Pectin in cough drops is a better choice for people with Chronic Cough. Chronic Cough is associated with dry and irritated throat and vocal cords.  For those people, menthol in cough drops worsens drying.  Mandel Sher recommends cough drops with pectin to patients with Chronic Cough.  Hall’s Breezers contain pectin, a more effective agent to temporarily provide a soothing layer on the surface of the throat.   Do Cough Drops Really Work?

Choosing the “best” cough drop depends on the precise cause of the cough.  For example, a wet cough,  possibly caused by chronic bronchitis or upper respiratory infection, acts differently and needs different cough treatment including cough drop than a Chronic Cough which is often dry.

Cough drops are big business.  Convenience Store annual cough drop sales are over $50 million.  Center for Cough’s face book page has reported a flurry of cough drop brand activity over the last several months.  Smith Bros. is being revitalized after a series of ownership transitions.  American Olympian swimmer, Ryan Lochte, has signed an endorsement deal with Pine Brothers.  And Ricola has teamed up with a web-based wellness app with the hope that users will suck on a Ricola cough drop everyday rather than wait until coughing begins.

Not all coughs are created equalIf you have recently been diagnosed and treated by your primary care physician for cough, but are still coughing, contact Dr. Mandel Sher at Center for Cough.  Cough that doesn’t go away is not normal and should be evaluated by a Cough Doctor.  Dr. Mandel Sher and Center for Cough team have a solution for your unique cough:  727-393-8067. 

Coughing from Red Tide?: Pinellas, Manatee, & Sarasota Counties

Can you smell it? Red Tide is back in the Tampa Bay area. Pinellas, Manatee and Sarasota Counties have red tide right now. IF YOU HAVE AN ACTIVE COUGH OR ARE COUGHING AT THE BEACH WHEN OTHERS ARE NOT, THEN YOU MAY BE HARD-WIRED TO COUGH. RED TIDE AND OTHER IRRITANTS MAY RESULT IN INTENSE COUGHING SPELLS. Contact Dr. Mandel Sher, Medical Director and Founder of Center for Cough, to precisely diagnose the cause of your cough and begin a comprehensive and effective cough treatment plan: 727-393-8067.

Red Tide can result in breathing difficulties, respiratory irritation (coughing, sneezing, tearing and an itchy throat) and/or serious illness for people with chronic respiratory conditions such as Chronic Cough. The Florida Department of Health advises people with severe or chronic respiratory conditions to avoid red tide areas.

Chronic Cough may be caused by more than one condition. Chronic Coughing spells may be triggered by more than one irritant. An overly sensitive cough mechanism, also known as hypersensitive cough reflex, is often a contributing factor to Chronic Cough. Some people are hard-wired to cough which simply means that the nerve endings at the back of the throat are easily irritated and ignite coughing spells. In these people, the cough reflex needs to be cooled-down with medication and easy-to-do at home voice exercises.

Each person and each cough is unique. That is why it is important to have your cough evaluated before beginning cough treatment. Sometimes, cough is an indication of an underlying and more serious medical problem. Sometimes, cough is THE problem. Rather than trying different cough treatments which may waste time, money and expose you to side effects or risks, get a cough treatment plan that is targeted specifically to your cough.

Are You Coughing from Red Tide?Red Tide occurs when there is a higher-than-normal concentration of a naturally occurring microscopic plantlike organism, specifically K. brevis, in the Gulf of Mexico and onshore wind conditions. K. brevis produces toxins that are released into the air when the organism dies and waves break open the cells. Red Tide is not new to this area. As far back as the mid-1800s fish kills were recorded. It occurs annually, usually in late summer or early fall, and lasts as long as wind and water conditions permit. Click on this link for the Florida Fish and Wildlife Conservation Commission’s “Red Tide Update Map:” http://myfwc.com/research/redtide/statewide/

Flu and Chronic Cough – a Bad Combination

Get Your Flu Shot Now!Influenza, also known as flu, is a contagious respiratory illness.  Flu and Chronic Cough are a bad combination.  If you are coughing after your flu is gone, call Dr.  Mandel Sher.  You may now have Chronic Cough and need different cough treatment.  Call Center for Cough at:  727-393-8067.

A bout of flu can be severe and result in serious complications for people who are considered to be high risk due to age or other medical conditions.  People who suffer with Chronic Cough are part of this high risk group.

Flu viruses are spread my droplets made when people with influenza cough, sneeze, or talk.  Sore throat, cough, and fatigue are flu symptoms that will usually go away in persons recovering.  But these can also be symptoms of Chronic Cough for months after virus is gone.  Dr. Mandel Sher and Center for Cough offer cough treatment for Chronic Cough resulting from seasonal flu and other upper respiratory infections.

Influenza viruses infect the nose, throat and lungs.  Cough receptors also live in these neighborhoods.  When viruses irritate the cough receptors, the result is acute cough.  People who are hard-wired to cough because they have a super-sensitive cough mechanism, also known as a hypersensitive cough reflex, may develop Chronic Cough from what began as acute cough.  Dr. Mandel Sher is a Cough Specialist.  He is one of very few doctors in the Tampa Bay area who is specially trained to do an advanced diagnostic test during an office visit to diagnose a hypersensitive cough reflex.

Chronic Cough is different from acute cough.  Chronic Cough has different causes and different treatments from acute cough.  Chronic Cough usually does not go away with time alone.  But there is effective cough treatment for people with Chronic Cough – even if they have seen other doctors for their cough and failed other cough treatments.  Over 80% of Dr. Sher’s cough patients demonstrate a measurable improvement in their cough and report a remarkable improvement in the quality of life.

The best defense against seasonal influenza is an offense.  Please GET A FLU SHOT NOW to protect yourself and those around you.  Generally, influenza season begins in October, peaks between December and March, and is active through May. Flu shot is already available throughout neighborhood pharmacies.

If you have a cough after the flu is gone, you may need cough treatment for Chronic Cough.  Call Dr.  Mandel Sher at Center for Cough at:  727-393-8067.


Madame Secretary, Her Allergies, and Chronic Cough

Secretary Clinton’s Chronic Cough and seasonal allergies are in the news!  But did you know that seasonal allergies can be only one trigger of Chronic Cough?

Chronic Cough is commonly triggered by upper airway irritation resulting from seasonal allergies, year-round allergies, non-allergic irritants, and chronic sinusitis.  Seasonal allergies, more commonly known as hay fever, are usually associated with grass pollen, ragweed pollen, and tree pollen during the growing and blooming season.  There are also year-round triggers for hay fever such as pet dander, dust mites, or cockroaches.

Frequent sneezing, red, watery, and itchy eyes, stuffy or runny nose, allergic shiners under the eye, and fatigue are the classic symptoms of allergies; cough can be an additional symptom.  Cough rarely occurs in the absence of other allergic symptoms, leaving allergy sufferers looking uncomfortable, sounding sick and contagious, and feeling miserable. Allergy symptoms, including cough, will occur soon after exposure and usually go away when the allergen is gone.

Chronic Cough is commonly triggered by post-nasal drip.

Post-nasal drip results from any upper air way irritation including seasonal and perennial allergies, post-viral residue, and chronic sinusitis to name a few examples.   All of these upper airway irritants cause membranes in the nose to produce mucus – some mucus drips from the nose and some trickles down the back of the throat, irritate the throat’s nerve endings, and trigger cough.

Persistent and lingering cough is not normal and you should not learn to live with it. 

Even if you think your cough is due to post nasal drip, be evaluated by a Cough Doctor to get an accurate diagnosis and cough treatment plan.   In the absence of information, your loved ones are worried and speculating that something more serious may really be going on.

Contact Dr. Mandel Sher at Center for Cough for cough treatment solution:  727-393-8067.    

Why Does Secretary Clinton Cough?









Hillary Clinton: Chronic Cough Ambassador

Secretary Clinton is a Chronic Cough Ambassador.  Dr. Mandel Sher has never evaluated Mrs. Clinton but believes she may be “hard-wired” to cough.  In the absence of information, there’s speculation.  Mrs. Clinton is again having coughing spells on the campaign trail, most recently in Tampa.  Bloggers, doctors, supporters and opponents are opining on the cause of the candidate’s persistent cough.  Seasonal allergies? Bronchitis? Cough is disruptive, distracting, and disconcerting.

Dr. Sher explains that Chronic Cough affects children and adults and men and women.  But, women of Mrs. Clinton’s age group are most affected.  Dr. Sher and other physicians and scientists around the globe believe that unexplained Chronic Cough has a neurogenic component.  Simply put, that means irritants cause the nerve endings at the back of the throat to become “on fire” and trigger coughing spells – that’s it.  In persons with neurogenic Chronic Cough, Cough is THE problem, not a symptom of an underlying medical condition.  Prescription medication and voice therapy can be effective treatments.

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Don’t let unexplained Chronic Cough be a distraction.  Don’t let unexplained Chronic Cough worry your family, friends, and colleagues.  Don’t let unexplained Chronic Cough give way to speculation about your health.

Dr. Mandel Sher is a Cough Doctor.  Not all coughs are created equal.  Dr. Sher will identify the cause of your unique cough and recommend a cough treatment plan targeted specifically to your cough’s causes and triggers.  Contact Center for Cough today:  727-393-8067.


Evidence and Guidelines Combine for Thoughtful Approach to Cough

Did you ever wonder how doctors approach taking care of patients’ specific conditions?

Dr. Mandel Sher’s approach to diagnosing and treating cough is consistent with Clinical Guidelines for Chronic Cough and Evidence-Based Medicine.  Medicare and commercial insurance companies cover Dr. Sher’s and Center for Cough’s services.

Clinical Guidelines for Practice and Evidence-Based Medicine are two factors that influence an individual doctor’s approach to each patient.   Both are important in creating and upholding standards and adding more certainty to decision-making.

Professional physician specialty societies issue clinical guidelines for practice.  Clinical practice guidelines are recommendations for doctors about the care of patients with specific conditions. These practice guidelines are based on research and experience.  The Institute of Medicine defines clinical practice guidelines as “…statements that include recommendations, intended to optimize patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options”

Evidence-based medicine  is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research,” according to Dr. David Sackett, a pioneer in this approach.

Today, Dr. Sher introduces one clinical guideline for Chronic Cough recently issued by the American College of Chest Physicians.  That professional society’s  journal, CHEST, featured:  “Treatment of Unexplained Chronic Cough:  Guideline and Expert Panel Report:”

“In adult patients with chronic cough, we suggest that patients with chronic cough undergo a guideline/protocol based assessment process that includes objective testing for bronchial hyperresponsiveness and eosinophilic bronchitis, or a therapeutic corticosteroid trial.”

Center for Cough’s blog addressed testing for eosinophilic bronchitis, Chronic Cough and Non-Asthmatic Eosinophilic Bronchitis, in August 2016.  Please click on these links to read the blog post on non-asthmatic eosinophilic bronchitis and other important cough topics.

Dr. Mandel Sher and Center for Cough team bring the highest professional clinical practice standards and knowledge from vast and successful experiences with cough patients to each and every cough patient interaction.  Please contact Center for Cough today to find out how Dr. Sher can help you achieve a lasting cough solution:  727-393-8067.



Chronic Cough and Non-Asthmatic Eosinophilic Bronchitis

Fractionated Exhaled Nitric Oxide (FeNO) is a diagnostic test to support a diagnosis of non-asthmatic eosinophilic bronchitis (NAEB)– There, we said it!  Both of these medical terms are mouthfuls that do not roll off the tongue easily.  But both are important in understanding another cause of Chronic Cough.  While NAEB is not as common a cause of Chronic Cough as asthma, GERD, postnasal drip, or irritated nerve endings at the back of the throat, NAEB is a cause that is under-diagnosed and under-treated and should not be overlooked.

Dr. Mandel Sher and Center for Cough is one of the few doctors in the Tampa Bay area and the west coast of Florida offering FeNO to make an accurate diagnosis and identify the underlying cause of Chronic Cough. 

FeNO is a relatively new, non-invasive, very accurate, easy, and inexpensive diagnostic test that trained doctors can use to support a diagnosis of asthma or non-asthmatic eosinophilic bronchitis.  NAEB has some of the same symptoms as asthma, but it is different.  Both asthma and non-asthmatic eosinophilic bronchitis can cause Chronic Cough and both can be treated and managed. feno

Fractional Exhaled Nitric Oxide (FeNO) challenge is a breath test that measures exhaled nitric oxide.  Nitric oxide is produced in the lungs and increased levels of nitric oxide in the breath can point to lung inflammation and asthma.  FeNO helps Dr. Sher and other cough doctors to quickly give patients who are suffering with Chronic Cough an understanding of the underlying cause.  This information hastens effective cough treatment by saving time and reducing patient use of over-the-counter and prescription medications that do not target the cause of their cough and may have side effects.

FeNO is a non-invasive and easy-to-do breath challenge.  When performed by a doctor trained in this diagnostic test, the resulting information is used to target cough treatment, specifically corticosteroids.  FeNO involves a patient breathing into an analyzer a few times over a course of minutes.  A doctor specially trained in using FeNO can identify abnormal scores and determine asthma or non-asthmatic eosinophilic bronchitis. In both cases, inflammation irritates the airway and prompts coughing.

There are many underlying medical conditions that can cause and trigger Chronic Cough.  In order to effectively normalize a persistent Chronic Cough, it is critically important that the underlying cause of your unique Chronic Cough be accurately identified and that treatment be targeted.

Prolonged cough is not normal and you should not learn to live with it.  Persistent cough that just won’t go away is a Chronic Cough and it should not be ignored.  Cough can be an indication of a serious underlying medical condition.  Contact Dr. Mandel Sher and Center for Cough for a solution that begins with accurate diagnosis and targeted cough treatment.