PHILADELPHIA (KYW Newsradio) — An email from a listener who says she has been coughing for over six weeks caught the attention of KYW Medical Editor Dr. Brian McDonough.
📧 Ask Dr. Brian
Email your questions to AskDrBrian@kywnewsradio.com.
Michelle Durham: This is not just a little cough spell or spasm. Rather, it has reached a point where she can't drive. It's difficult to work. It's really interfering with her life. I know there's lots of bugs going around, but this doesn't sound like one.
Dr. Brian McDonough: Obviously, we all know that smoking and those things can lead to chronic cough. Asthma can, as well. But there are other common causes.
One of the biggest ones -- and this time of year, we're seeing it -- is fluid that drips from the nose down the back of the throat, so-called post-nasal drip, that actually can come down and cause coughing over and over again. It'll be very annoying. Some people have that; that goes on for weeks.
The other is if you have reflux. If you have acid buildup, you actually can have it from the stomach up, and the acid reflux can cause chronic cough as well.
Another one you have to think about is the medications we use for blood pressure -- the ACEs or the ARBs, and those of you who are on them will know those groups -- they can sometimes cause a cough. I would not stop a blood pressure pill, in that case, but that's something to talk to your doctor about.
Then of course, you think about infection, and that's clearly something that we would worry about. There is a cough -- we call it the "100-day cough" -- which is the pertussis cough.
Pertussis is what we always called, in the past, whooping cough -- although that whoop doesn't occur as much as it used to. But that's a contagious respiratory illness that can last for weeks.
There is a vaccine against pertussis, and people get it certainly as children, and it protects them. That's very important. But when you're older, it may have waned. In fact, we tell grandparents and parents to get a booster because, if you're around young children before they've had it, you certainly don't want kids to get it.
What's the first course of action for you as a physician when this person presents with just a cough that won't go away? Is it blood test? Is it pulmonary function? What are you looking to do?
So she comes to me with these symptoms, the first thing I would do, which we always do, is get a really good history, find out exactly what's going on, what makes it worse.
The next part is the physical exam, and that would be looking in the throat, looking for postnasal drip, pushing against the sinuses to see if there's pressure, and then listening to the lungs and finding out is there's something going on in the lungs.
So you look at any physical examination because that could help you in your judgment, and that would lead you down pathways to, for instance, do testing. We don't do chest X-rays like we used to, unless we're really suspecting an issue like a pneumonia or something like that. But in other cases, it might be an ear, nose and throat. Either something we can do with a course of antibiotics, or send them to an ear, nose and throat specialist who can do even deeper looks at the issues and check that out and maybe even extra tests.
So it all depends what they come up with, but I think the big message from my perspective is, if your coughing is going more than a week, or if you're running a fever with your cough or have other symptoms, definitely get seen. And it's really important. I believe there's a good role for emergency rooms and urgent care, but if you have a doctor, that person who knows you can really evaluate you and and work you through it, because you shouldn't have to suffer.