By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER SHOULD URGE HER FATHER TO SEE DOCTOR ABOUT CHRONIC COUGH

Question: I visited my parents recently and noticed that my dad coughed all the time. He never smoked, and I have never noticed this before. When I asked him about it, he said it didn’t bother him. When I asked my mother about the cough, she said that she doesn’t notice it much anymore. He hasn’t been sick, running a fever or getting any worse. He doesn’t think he needs to go to the doctor. Should he?

Answer: Chronic cough is a very common cause of a trip to the doctor. The chronic cough, one lasting for several weeks, is a symptom of something else going on and is not a disease itself. There are many things that can cause a chronic cough, and most of them are not serious but are quite treatable. Of course, cigarette smoking tops the list of causes for chronic coughs, but in your father’s case, this does not apply.

Chronic drainage from the nasal sinuses -- often called postnasal drip -- can also cause a cough that lingers for quite a while, even year-round. Acid reflux, or GERD, causes fluids from the esophagus to collect in the throat and can lead to chronic throat clearing and cough. More serious problems, like bronchitis, asthma and pneumonia can cause prolonged coughing. Some medicines, especially blood pressure medication, can cause a chronic cough.

A visit to the doctor can start the diagnostic process. Many times a chest X-ray is done. While it seldom tells you what is wrong, it often tells you what is not wrong. For instance, it can rule out a tumor or foreign body, as well as pneumonia. If your father complains of a lot of postnasal drip, his doctor may want to look at X-rays of the front part of his skull to see what is going on in the sinuses.

Sometimes the doctor will ask for an upper GI endoscopy if he or she suspects GERD. This is a test where the doctor inserts a fiberoptic tube through the mouth and down into the esophagus, stomach and duodenum. As sedatives are given, the procedure is easily tolerated by most patients.

The treatment of a chronic cough is aimed at treating the cause, so getting the problem diagnosed is really important. Sinus problems are frequently treated with antihistamines and decongestants. There are several medications to decrease the symptoms of GERD -- some neutralize stomach acid and others reduce the production of acid. Bronchitis, pneumonia and asthma also need to be diagnosed and treated with appropriate medications.

If your father’s chronic cough is due to medication for high blood pressure, his doctor may be able to switch him to another drug. Fortunately, there are many classes of blood pressure medications that do not cause cough, and most people tolerate changes in blood pressure meds quite well.

Finally, I’d urge you to not let this go because inaction can lead to lifestyle changes and isolation. Many times the spouse is annoyed by the cough and won’t even be in the same room as the cougher. Social occasions can become embarrassing for the person with a chronic cough. And, the problem here is not just the chronic cough itself. In many people, chronic coughing can cause urinary incontinence, as well. So, please encourage your father to see his physician to get to the root of the problem.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.