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How Referral to an Allergy/Immunology Physician can Help in the Diagnosis and Management of Patients with Chronic Cough
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Chronic cough is defined as being present for greater than eight weeks. The most common causes of chronic cough include postnasal drainage, asthma, and gastroesophageal reflux disease (often associated with heartburn or acid indigestion). One or a combination of these three conditions is the cause of chronic cough in the majority of otherwise well patients. Other common causes include chronic bronchitis secondary to cigarette smoking or passive exposure to cigarette smoke or secondary to a type of blood pressure medication (ACE inhibitor). Allergists have extensive and unique training to evaluate patients with these diagnoses.
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Postnasal drainage is the most common cause of chronic cough. This is often due to hayfever (allergic rhinitis) and/or sinusitis. Allergists can perform skin testing to determine specific allergic sensitivities. Treatment consists of avoiding allergic and nonallergic triggers as well as medical treatment with antihistamines, decongestants, and/or topical prescription nasal sprays and potentially allergy desensitization.
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Cough is a very common symptom in patients with asthma. Approximately 25% of patients with chronic cough will have underlying asthma. In some patients cough may be the only symptom—in other words no wheezing or shortness of breath will be present. Allergist-immunologists can perform pulmonary function testing, such as spirometry, which is often useful to confirm a diagnosis of asthma. Allergist-immunologists can also perform specialized pulmonary function tests, such as a methacholine challenges, which may be necessary to determine that a chronic cough is due to asthma. Avoiding allergic and nonallergic factors is an important treatment modality that allergists can help patients with. Treatment with asthma medication can often relieve the chronic cough, and allergist-immunologists are experts in the use of asthma medications.
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Gastroesophageal reflux disease (GERD) is another common cause of chronic cough. This may be present with symptoms of GERD (i.e. heartburn), but also can be the cause of cough in the absence of feeling heartburn (silent GERD). If GERD is suspected to be contributing to chronic cough, allergist-immunologists can prescribe empiric treatment with medication as well as diet and lifestyle changes that can greatly improve the cough.
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In some patients treatment for all three conditions—postnasal drainage, asthma, GERD—may be needed to relieve chronic cough. Allergist-immunologists can provide optimal therapy for all three conditions.
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