The Allergist’s Role in Treating Chronic Cough – Part 1

I’m always amazed that as diverse as an allergist’s private practice can be with a myriad of different problems- that the same complaints seem to come in clusters. This has definitely been the case for the month of July. July in my office has been a refuge for patients suffering with a chronic cough.

A good patient definition of a chronic cough is when your family, friends or loved ones strongly recommend you see a doctor about your cough. A cough is not usually deadly, but it is annoying and exhausting to the patients who can’t seem to shake it. This time of year it’s unusual for an infection to be the main cause of a chronic cough. The reason being: less crowding on subways and buses, people are outdoors more.

My job, as an NYC Allergist, is to explain to new patients with a chronic cough what is the underlying cause for their cough, so we can treat the problem and not just suppress the symptom itself. I sometimes see, unfortunately, a physician will use codeine products to give their patients relief from the severe, chronic cough- this can be problematic. I’ve rarely seen it work long-term and the side-effects are usually intolerable for the patient.

My approach with the patient is to look at 3 systems: the nose, the lung, and the stomach. These are frequently the areas where a cough is emanating from. My job as an Allergist and Sinus specialist is to determine if nasal blockage due to airborne allergies or due to anatomical problems (deviated septum or polyps). I specifically test for common outdoor and indoor allergens, such as pollen, pets, dust, and mold, which can cause swelling of the nasal passages and ultimately cause post-nasal drip into the back of the throat and lungs- causing the incessant cough.

I find the short-term solution in these patients is to decongest the nose but without oral decongestants. I use topical decongestants that must be used with a mild prescription spray- so you don’t get the rebound effect from the decongestant spray. I then wean the patient off the decongestant spray and just use the prescription spray. This can be very effective. If the patient has positive allergy tests that indicate this as the cause of the nasal congestion, I will present to the individual the option of sublingual allergy immunotherapy (allergy drops) for a more natural and long-term solution to a chronic cough.

The next installment will be about the lung causes of a chronic cough…

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island