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. 


Coughing is Natural, But is Your Cough Normal?




Normalize your cough. Don’t stop it! 

You’ve probably used the expression, “Cough it up!” While this slang usually means “hand it over or give it up,” it refers to the body’s all important cough function.  Cough has a vital role in getting rid of foreign objects before they are inhaled into our respiratory system and end-up in our lungs.  So, coughing is natural, but is your cough normal? Read more


(Cough-Cough) Symphony Anxiety: Original Poem


Oh, the anxiety associated with your persistent cough…Can you manage your cough long enough to get through the symphony performance without interruption?

Dr. Mandel Sher’s cough colleague from the United Kingdom shared an original poem written by a cough patient.  The sense of looming embarrassment  from coughing at an inopportune time, and the sense of relief that comes with getting through a public gathering uneventfully, are universal feelings of persons with cough.

Don’t allow cough anxiety to interrupt or limit your life – Dr. Mandel Sher has a solution for your unique cough.  Contact Center for Cough today to find out how Dr. Sher can help you:  727-393-8067.
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FOX 13 Interviews Dr. Sher



Fox 13’s Dr. “Jo” recently visited Dr. Mandel Sher and Center for Cough patient, Joan M. Joan described the 8-year cough nightmare that made it hard for her to leave her home. Dr. Sher commented on new findings about a cause of chronic cough and promising new cough treatment. CLICK HERE TO WATCH THE VIDEO

Help increase Chronic Cough awareness! Please SHARE this video and article with 5 people.

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Cough Mystery Solved: Foreign Body Aspiration


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Welcome to the cough mystery solved – a surprising diagnosis of the case study presented by Dr. Lisa Sanders in the New York Times. Spoiler Alert:  The surprising diagnosis is foreign body aspiration.   Read on to follow the steps that led to this conclusion.

In Part 1, a 43-year old man had been suffering from an annoying and persistent cough for 18 months.  During this time, he saw a primary care physician, ear-nose-and-throat specialist and pulmonologist for his cough.  His doctors prescribed an antihistamine for allergies, an inhaler for asthma, and antacid medication for heartburn – but the cough did not go away.  So, the man tried to learn to live with the persistent cough. Then, he began coughing-up blood. Read more

Cough Mystery: Can You Solve It?

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Think Like a Doctor: A Cough That Won’t Stop,” by Lisa Sanders, M.D. in the NY Times Magazine presents an unsolved cough mystery.  In the first of a 2-part series, Dr. Sanders presents the case, and then reveals the diagnosis the following week.  See if you can guess the diagnosis correctly after you read this case study.

The patient presented in this case study is typical of the cough patient that Dr. Mandel Sher and Center for Cough diagnose and treat.  Read more


Global Cough Leaders Meet in London


Dr. Mandel Sher is back fresh from the Ninth International Symposium on Cough held in London from June 29th through July 1, 2016. The international symposium was organized by Professor Kian Fan Chung, Professor of Respiratory Medicine at the National Heart & Lung Institute of the Imperial College London. The symposium attracts global cough leaders in the treatment of cough and scientific cough research. Read more