One of the common complaints secondary only to shortness of breath that I seem to encounter in the office setting is that of chronic cough. For the most part cough is not primarily a pulmonary symptom. The classic triad of disorders associated with chronic cough lung disease of some sort is only one. The three general conditions associated with chronic cough are post nasal drip, gastrointestional reflux disease or lung disease most commonly asthma. I have written many articles over the last twelve years on each of these subjects. However, despite looking for these conditions in patients affected by chronic cough the treatment approach is often less than satisfactory for both the patient and the physician. Some reasons for this lack of satisfaction include the complexity of the work up and the treatment plans which often include changes in life style and annoying treatments such as nasal lavage.
There has been any number of attempts at medications for the treatment of chronic cough primarily because there are a number of patients who do not meet the criteria for any of the common disorders and who fail to respond to anything.
For many of the patients with prolonged cough, sometimes lasting years, the diagnosis may be cough hypersensitivity syndrome which is abnormal stimulation of the cough reflex due to central and peripheral neurologic stimuli. Medications have been applied to this condition with varying success. Currently, we are still searching for the best approach to this neurologic condition