A Coughing Fix

Tried enough over-the-counter cough medicines to last a lifetime? Those with chronic coughs may finally get some relief.

After countless cough drops, cough syrups of every flavor and too many trips to the doctor, you're still coughing -- and miserable. An estimated 23 million Americans see their physicians each year because of a cough. For many, the cough hangs on for weeks, months and even years.

Chronic cough takes a toll on patients, both physically and mentally, according to a recent survey of 146 cough patients at Mayo Clinic. Coughing causes incontinence, drives spouses out of the bedroom and makes socializing difficult. Patients report frustration, irritability and anger, in part because pinpointing the cause of chronic cough can be difficult. More than one illness can contribute to it. Adding to the mystery, chronic cough can disappear and recur for no apparent reason.

"It's not unusual for patients to give up and resign themselves to living with the cough," says Kaiser Lim, M.D., a Mayo Clinic pulmonologist and allergist.

Dr. Lim and a team of Mayo Clinic researchers recently presented results of a study that could help doctors get to the cause of a cough faster. "Sinusitis, an inflammation or swelling of sinus passages, is a common and often overlooked cause of chronic cough," Dr. Lim says. Treating the sinusitis can relieve the irksome cough.

Treatment options include corticosteroids, antifungal sprays, or in severe cases, surgery. In the retrospective study, researchers obtained CT scans of the sinuses for 132 patients with chronic cough who were suspected of having sinusitis. Researchers found that sinusitis was the cause of the chronic cough in 37 percent of the patients.

Dr. Lim says that sinusitis perhaps has been overlooked because its symptom, mucus draining down the throat, can be caused by other conditions. Doctors need to confirm the diagnosis of chronic sinusitis with a CT scan or a look into the nasal passages with a special scope.

Sinusitis hasn't been at the top of the "usual suspects" list for causing chronic cough. But it should be up there, Dr. Lim says, especially for those who have a history of sinusitis or past sinus surgery. The study indicates that sinusitis is among the most likely causes of chronic cough, along with acid reflux, rhinitis (inflammation of the nasal passage) and asthma.

Quieting a chronic cough still isn't going to happen overnight, Lim says, but for a significant number of patients, finding the cause of chronic cough could make treating it much easier.