Question:
Why am I always coughing? Is it allergy? Is it asthma? Do I have an infection? I took 2 courses of antibiotics but my chronic cough did not go away, so I had a chest X-ray, which was normal. I took allergy medication, and it still did not go away. My doctor gave me inhalers to treat asthma and the cough is still there. The only thing that helps is cough syrup, but I am tired of taking that. Some days I feel better and I think the problem has resolved, but the next day the cough is back.
Answer:
As a physician, I see patients with this complaint 3 to 4 times a day. They often try multiple treatment regimens for a variety of diagnoses with no resolution of the symptoms. The reason is simply that the diagnosis is wrong. Dry coughs are not typical of infection, and without other allergy symptoms (congestion, itchy eyes, sneezing and runny nose) the problem is usually not allergy. Throwing medications at the symptoms does not manage the cause.
Cause
The cause in most cases is a type of acid reflux called laryngopharyngeal reflux, or LPR. LPR is not usually associated with indigestion and heartburn—the classic symptoms of gastroesophageal reflux disease (GERD), a similar condition—thus the diagnosis is not an obvious one. When acid comes up into the back of the throat, there is a localized swelling behind the vocal cords and thick mucous often coats the area to prevent ulcers. The swelling causes a constant tickle in the throat and an annoying cough. Symptoms of post-nasal drip and throat clearing may be associated, but not always.
Treatment
Try the following to relieve your symptoms:
• Take over-the-counter reflux medication daily in the morning.
• Avoid eating late at night.
• Cut down on highly acidic foods.
• Elevate the head of your bed.
For some people, without the medication the cough can return. You can follow up with an ENT physician for an exam and assistance with a treatment regimen.
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