Getting to the Bottom of Chronic Cough

Do you have a cough you just can’t seem to shake? Whether it’s racking spasms that leave you red in the face and gasping for air, an irritating distraction that interferes with sleep or other activities, or just an annoying tickle in the throat that has to be “scratched,” chronic cough significantly impairs quality of life.

Let’s take a look at the usual—and some unusual, yet treatable—causes for this very common condition.

• Is it respiratory? Respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD) are the most obvious culprits in chronic cough. But you’d be surprised at how often these conditions are overlooked when symptoms are as “mild” as a persistent cough. Most of these coughs respond to appropriate treatment.

• Control GERD, eliminate coughing. Coughing isn’t always initiated in the respiratory system. Another leading trigger is gastroesophageal reflux disease (GERD). If you discuss this with your physician, be prepared to get a prescription for a proton pump inhibitor (PPI) or other acid-suppressing drug. But before you agree to meds, I urge you to try a safe, inexpensive supplement called deglycyrrhizinated licorice (DGL). The recommended dose of deglycyrrhizinated licorice (DGL) is one tablet, chewed 20 minutes before meals.

• Could it be a vitamin B12 deficiency? Another hidden problem that may contribute to chronic cough is sensory neuropathy. Damage to nerves in the larynx can lead to hypersensitivity and increased responsiveness to allergens, reflux, and other irritants. If you have an unresolved cough, give vitamin B12 supplements (1,000 mcg daily) a try. There’s an erroneous belief that injections or sublingual tablets are the only way to raise blood levels of this vitamin, but oral B12 works just fine. It’s safe, well tolerated—and just might be the answer to your chronic cough.

• Drugs could be the problem. Finally, do not overlook the possibility that chronic cough may be iatrogenic, or inadvertently caused by medical treatment, in this case by drugs. ACE inhibitors, a popular class of medications for heart disease, hypertension, and heart failure, promote a chronic dry cough in one in four patients who take them—and it’s severe enough that a good percentage of them discontinue the drug. Beta-blockers, also used to treat cardiovascular issues, are problematic as well, though to a much lesser degree. If you’re taking either of these meds, talk to your doctor about replacing them, preferably with side effect–free, nondrug therapies.

Now it’s your turn: Have you suffered from a chronic cough?

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