Chronic cough

For this topic, I’ll begin with a recent patient encounter:

“11y/o male patient with history of asthma and allergies, seeing me for first time with Mom, has been seen with our providers here for the past 3-4 months for a chronic, persistent cough. In review, he was seen and treated by 2 of our for asthma and likely whooping cough with various inhalers, codeine cough syrup, Tessalon Perles (cough tabs), Singulair, Claritin, Advair, steroids and Azithromycin (antibiotic). His most recent appointment was a week ago, where he was treated a second time with steroids and antibiotics due to the persistent, dry cough occurring in fits. He denies sick contacts, shortness of breath, fever, post nasal drainage, wheezing, or night time cough. He’s been skin tested for allergies, with +horse hair and tree allergies. He notes some mild acid taste in throat occasionally. There is no smoke exposure. He never had a swab to confirm Pertussis (whooping cough infection) and a chest x-ray done in January which was negative”.

His mother and I racked our brains for the cause of his never-ending cough. It was now keeping him, a straight A-student, out of school, due to the disruption of his fits of cough. It was distracting to him and his classmates and was embarrassing. It was concerning to his mother because nothing worked. She wanted him to see a lung specialist. After various trials of cough medicines, antibiotics, asthma inhalers, and allergy medicines, the cough was non-stop.

Causes of chronic cough generally include the following: side effects from medicines, allergies and mucus production, asthma, respiratory infections, and acid reflux. With GERD, or gastro-esophageal reflux disease, there is increased acid production and decreased acid suppression in the stomach. The acid rises and ascends up the esophagus into the pharynx, or back of the throat, and irritates the vocal cords. Sometimes, it can also cause growths, or cysts, on the vocal cords, which can cause hoarseness out of nowhere, or produce a chronic cough.

For this patient, we’d already treated him for allergies, asthma, and infection multiple times. After thinking, I realized his cough probably started out as a whooping cough infection, but after many rounds of antibiotics and chronic irritation, he was likely developing some acid reflux on top of it. We tried Zantac twice a day, and his cough quickly stopped. Success! He was still seen with a lung specialist for follow up, but by then, his cough was gone. I saw his mother later and she was very pleased the cough was gone, and he could return to school without embarrassment. 

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