Diagnosis & Treatment

Diagnosing Chronic Cough

You May Be Hardwired To Cough!

Everyone coughs.  Cough is the body’s defense mechanism to protect us from choking or inhaling foreign particles. But some coughs have no purpose.  A persistent cough, also known as a chronic cough, is simply irritating to you and annoying to others.  This type of generally dry and constant cough is caused by a hypersensitive cough response.  People who have a chronic cough that is caused by a hypersensitive cough response are hardwired to cough.  Simply put, the nerve endings at the back of the throat are overly-sensitive, easily irritated, and result in chronic cough. In the medical literature, this type of cough is referred to as “hypersensitive cough reflex.”  In order to optimize the effectiveness of your chronic cough treatment, accurately diagnosing the underlying reason(s) for coughing is essential.

Diagnosis includes identifying your persistent cough’s triggers, otherwise known as the irritants that produce cough.  Very often, there are multiple triggers.  Common irritants that result in cough in those people who have a hypersensitive cough response are:  post nasal drip, acid and non-acid reflux, and cough asthma/lung inflammation.

In almost all cases, Dr. Sher will diagnose the cause and trigger(s) of your cough and develop a personalized treatment plan targeted at your unique cough during the initial evaluation.

The initial evaluation includes a thorough medical history and physical exam exploring your cough symptoms and their consequences. Previous physician visits, laboratory testing, X-rays, and diagnostic procedures will be reviewed. Then, further testing may be performed during this visit using advanced diagnostic tools.  The tools may include:

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

Chronic Cough Treatment

Treating  the persistent cough

Chronic cough treatment includes treating cough reflex hypersensitivity and the identified anatomic causes  which can include upper airway/post nasal drip,  acid and non-acid reflux and cough asthma/lung inflammation

The cough reflex has three components: neurogenic, inflammatory, and behavioral. There is no ideal neurogenic cough suppressant available but there are over the counter and prescription medications that can help. If your cough has an inflammatory component and that inflammation is activating the nervous system resulting in activated nerves to cause inflammation, then anti-inflammatory medications can be very effective. If your cough is being influenced from upper brain function and may have a behavioral component, then voice therapy and exercises can be helpful.

Your individual cough profile will identify the neurogenic, inflammatory and behavioral components of your unique cough. Once Dr. Sher assesses your cough’s components, effective treatment can begin. Very often, treatment is a combination of over the counter medications, prescription medications, diet modifications, and easy, fast and do at home voice exercises. Sustainable success is enhanced by an ongoing partnership between the Center for Cough team and the patient.