Allergic Diseases, S.C. Steven H. Cohen, M.D.
Home Doctor First Visit Office Policies Medical Info Asthma Allergies Bronchodilators Stinging Insects Itch Cough Allergy Vaccine Therapy Mold Clinical Trials Contact Us FAQs Links	The Story of Cough “A cough is something that you yourself can’t help, but everybody else does on purpose just to torment you.” Ogden Nash The American Heritage Dictionary of the English Language defines cough as the sudden and noisy expulsion of air from the lungs, often to keep the respiratory passages free of irritating material. It is also a very common presenting symptom in clinical practice. In fact, it is the most common respiratory symptom for which patients seek medical attention according to the American Academy of Allergy, Asthma and Immunology (AAAAI). Cough can be defined as either acute or chronic. Acute cough is usually self-limiting and generally lasts one to two weeks. The cause of acute cough is most commonly a viral respiratory infection. Chronic cough, on the other hand, tends to attract the most attention from clinicians and patients alike. It is generally defined as lasting more than four weeks. Many patients will seek medical attention with chronic cough for fear of having an underlying disease. Chronic cough has been shown to result from a collection of conditions. The main cause is probably Chronic Bronchitis due to cigarette smoking. Other common causes include the use of ACE inhibitors; various forms of Rhinitis including Seasonal Rhinitis and Perennial Rhinitis due to Allergies; Asthma; and Gastroesophageal Reflux Disease (GERD). Asthma, in fact, has been theorized to be the second-most common cause of chronic cough in adults, according to Daniel A. Culver, DO and Mani S. Kavuru, MD of The Cleveland Clinic Disease Management Project. Cough is present in almost all cases of asthma. When a patient presents with chronic cough a thorough history should be taken including such things as whether symptoms are worse at night or during the day, if there are seasonal variations to the cough, etc. Physical examination and studies such as Pulmonary Function Tests, chest x-rays, CT scans of the chest or sinuses and Methacholine Challenge, if asthma is suspected, all contribute to a diagnosis. An Allergy Evaluation is useful in cases of cough lasting 3-8 weeks or more, when cough co-exists with asthma, when chronic cough co-exists with nasal symptoms or when a patient has chronic cough and associated tobacco use or exposure, according to the AAAAI. Allergy evaluation will include skin testing, sinus evaluation for potential chronic sinus disease and, possibly, laboratory studies. Asthma patients frequently have an allergic component to their asthma, so an allergy evaluation is often recommended in these cases. If GERD is suspected as the underlying cause of chronic cough an endoscopy will be done to diagnose this condition. Treatment of chronic cough is tied to the underlying diagnosis. Medications for allergies, asthma and GERD are used with great effectiveness. If an allergic component of chronic cough does not improve with these medications, Allergy Immunotherapy (allergy injections) can be most effective in providing relief to patients and an improvement in their quality of life. Cough can be annoying, cause hoarseness, insomnia, muscle pain, exhaustion and urinary incontinence. It can be a symptom of a critical underlying condition. It should be taken seriously and never ignored. Even performers and actors seem to be acutely aware of this concept, as illustrated by the following quotes: “The audience is the best judge of anything. They cannot be lied to. Truth brings them closer. A moment that lags– they’re gonna cough.” Barbra Streisand, actress, singer “Acting is merely the art of keeping a large group of people from coughing.” Sir Ralph Richardson, actor “Coughing in the theater is not a respiratory ailment. It is a criticism.” Alan Jay Lerner, dramatist, composer “What was wrong with those people tonight? Never have I heard such a cacophony of coughs before! Is there an epidemic? Slap them! Do me a favor, slap them, it was awful!” Maggie Smith, actress “I never let them cough. They wouldn’t dare.” Ethel Barrymore, actress A Poem For the Coughing Among Us I’m Sick And I Cannot Go To School Today By Shel Silverstein ”I have the measles and the mumps, A gash, a rash, and purple bumps. My mouth is wet, my throat is dry, I’m going blind in my right eye. My tonsils are as big as rocks, I’ve counted sixteen chicken pox. And there’s one more … that’s seventeen! And don’t you think … my face looks green? My leg is cut, my eyes are blue, It might be instamatic flu. I cough and sneeze and gasp and choke, I’m sure that my left leg is broke. My hip hurts when I move my chin, My belly button’s caving in, My back is wrenched, my ankle’s sprained, My ‘pendix pains each time it rains. My nose is cold, my toes are numb, I have a sliver in my thumb. My neck is stiff, my spine is weak. I hardly whisper when I speak. My tongue is filling up my mouth, I think my hair is falling out. My elbow’s bent — my spine ain’t straight. My temperature is one-o-eight. My brain is shrunk, I cannot hear, There is a hole inside my ear. I have a hangnail, and my heart is …….WHAT? What’s that? What’s that you say? You say today is …...Saturday? G’bye, I’m going out to play!”      11121 W. Oklahoma Avenue    West Allis, WI 53227    Tel: 414.545.1111