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Medical Edge Newspaper Column from Mayo Clinic

MANY POSSIBLE CAUSES MAKE CHRONIC COUGH HARD TO DIAGNOSE

DEAR MAYO CLINIC: I have been coughing for more than 10 years and have been diagnosed with asthma. My asthma (if that is the problem) is cough-induced. I have received treatment from several pulmonologists without relief. What else can I do? — Memphis, Tenn.

ANSWER: I’m sorry for your frustration. Evaluating a chronic cough can be difficult. Please note that uncontrolled asthma may be accompanied by a chronic cough. However, cough does not induce asthma. If you haven’t responded to good asthma treatment, it may be that your cough is not due to asthma but caused by something else.

For most nonsmoking patients, the diagnostic approach is a systematic elimination of probable causes:

— Postnasal drip from rhinitis or sinusitis.

— Asthma, which inflames and constricts air passages.

— Gastroesophageal reflux : the backup of stomach acid into your esophagus.

— Other diseases that affect the bronchopulmonary tree, such as smoking-related conditions (chronic obstructive pulmonary disease); tumors (endobronchial growths); and abnormalities of the breathing tubes within the lungs (bronchiectasis).

— Some medications. Angiotensin converting enzyme, or ACE, antagonists can cause cough.

It is not unusual for patients to have more than one cause contributing to the chronic cough, which makes reaching a diagnosis even harder.

Even after an abnormality has been identified, it doesn’t necessarily mean that the cause of cough has been found. The abnormality has to be specifically treated first. When the cough clears up or responds to treatment, we then know the abnormality contributed to the cough.

Chronic cough has the tendency to worsen and improve on its own. It may also recur after being treated and not respond to the same therapy again. This may be why you have found it to be very frustrating.

I’d recommend that you seek out a doctor who is willing to take a step-by-step approach to look at the entire list of possible causes and then develop an appropriate treatment plan.

And even with the most thorough workup, sometimes the cause of the cough remains unknown. Still, your doctor should be able to offer treatment options to better manage the cough.

— Kaiser Lim, M.D. Pulmonology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Information on a Chronic Cough
Appointment Information
More Information on Chronic Coughs

READERS: You trip, hit your head and see stars. You get bonked on the head — hard — with a ball. At some time, most of us suffer a blow to the noggin. Fortunately, most head injuries are minor and can be treated with basic first aid.

But head injury can also be life-threatening. This is particularly true if it involves a loss of consciousness, even if only briefly. Another concern after serious head injury is possible unseen bleeding that affects the brain. Bleeding on the surface of the brain or within the brain is serious, and can damage the brain.

Be sure to seek emergency care and evaluation if any of the following occurs after head trauma:

— Loss of consciousness, which may occur a few hours after the injury

— Dazed or confused feeling

— Memory loss

— Nausea or vomiting

— New neck pain

— Numbness or weakness of the extremities

— Unusual or prolonged headache

— Bruising or discoloration around the eyes or behind the ears

— Blood or clear, watery fluid coming from the ears or nose
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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.