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Chronic cough is a very frustrating and aggravating problem. It may or may not be related to allergies. However, if we are persistent enough in our efforts, we can almost always either cure or control chronic cough.

As long as your chest X-ray is normal, there are three conditions that either alone, or in some combination, cause the vast majority of chronic cough cases. The most common cause is post-nasal drip. This implies a chronic nasal or sinus condition which could be allergic.

While allergies can cause chronic nasal and sinus symptoms, there are many non-allergic nasal conditions as well. Seasonal allergies can often be diagnosed by history. Perennial allergies, however, often require allergy testing to confirm the diagnosis.

If one has nasal allergies, there are three methods of treatment. First, one should avoid exposure to situations that seem to trigger the allergy (i.e., dust, pollen, etc.). Next, we try medications to suppress allergic symptoms. Some medications can be used on an as needed basis for immediate relief of symptoms, while others must be taken daily to suppress allergic symptoms.

One must remember that allergy medicines do not cure allergies. For patients with severe allergies, the final treatment strategy involves allergy shots or desensitization. While allergy shots take a long time to work, they can permanently reduce and sometimes cure allergies. Patients with chronic non-allergic nasal conditions can only take medications to suppress their symptoms.

One condition worthy of mention is chronic sinusitis which is chronic inflammation and infection of the sinus cavities. It too may or may not be related to allergies. While chronic sinusitis is more common than hypertension and diabetes, the diagnosis can be very difficult, often requiring a sinus CT scan to detect. Treatment usually involves an extended course of antibiotics, treatment of allergies when present, and sometimes sinus surgery.

The second most common cause of chronic cough is cough-variant asthma. While most asthmatics also experience wheezing, chest tightness and shortness of breath, some asthmatics will only cough. Cough variant asthma can be a difficult diagnosis, even for experienced physicians, and often requires lung function testing or a trial of asthma medication to confirm. Treatment is the same as any chronic asthma case, often requiring daily suppressive medications to control.

The third most common cause of chronic cough is acid reflux. While most persons will experience heartburn, a significant minority of patients can have no symptoms, or silent reflux, making this a difficult diagnosis. A test for acid reflux or an extended trial of anti-reflux medications may be required to diagnose silent reflux.

Many chronic cough patients can have two or all three of the conditions simultaneously and must be treated for all active problems to control the cough. A small minority of chronic cough patients have other causes and may require additional tests to determine that cause. However, if the doctor and patient work together, almost all cases of chronic cough can be cured or controlled.

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