Mucus usually passes down the throat to the esophagus. If it instead lands on the vocal cords, it can pass into the windpipe and then into the lungs. When this occurs, your body will rely on another protective mechanism: You will start coughing so that the mucus does not continue to travel along this path. You cough to expel the mucus from the airways. We often think that coughing is bad; although coughing can be irritating, coughing is really necessary to defend your lungs against infection.
However, constant or chronic coughing is a symptom that must be dealt with because it can lead to other, more significant problems. For example, women often report that incontinence accompanies bouts of
coughing. Chronic cough is defined as a cough lasting over 3 weeks. Chronic cough is not contagious. Many who suffer from chronic cough can’t sleep, and their significant others are awakened by their coughing fits. Even today, there is no single test that will determine what is causing a chronic cough. Instead, most doctors will have you go through a systematic elimination of probable causes. We know that the most common causes for chronic cough include those related to CAID: asthma, postnasal drip, chronic rhinosinusitis, LPRD and/or GERD. In a recent Mayo Clinic study, researchers found that more than one third of chronic cough patients were also experiencing an inflammation of the sinuses. It now seems that underlying sinus inflammation should be considered as a major cause of chronic cough.
Yet CAID, and even sinusitis alone, is often overlooked by physicians as a culprit in chronic cough. The high percentage of sinus inflammation in patients with cough in the Mayo Clinic study suggests that those individuals should be seen by an otolaryngologist, who specializes in sinus problems and cough. Yet many people with chronic cough are instead treated by their primary-care physician (internist, family physician, or pediatrician) or a pulmonologist (lung specialist). Unfortunately, these physicians typically never address the sinus problem that is causing the cough, and these patients never get better.
In addition, many have been told by their physicians to learn to live with their coughs. Worse, they have been mistakenly diagnosed as having a nervous cough, which means that their coughs are triggered by being in an uncomfortable situation. I do not believe that there is such a condition as a nervous cough, and there is no diagnosis code for nervous cough in the International Classification of Diseases, the reference site all physicians use to classify a diagnosis. In my mind, this diagnosis is made when the physician can’t figure out what is causing a cough.
Chronic cough can have adverse social, psychological, or physical effects. I always tell the families of my patients that even if the cough is disturbing to them, they need to have some empathy because most people who suffer from a chronic cough just want to jump out of their own skin. In another Mayo Clinic survey, researchers found that chronic cough patients reported significant social and emotional problems. They were
frustrated, irritable, and angry over the ineffectiveness of therapies. They felt helplessness, which had a profound effect on their quality of life. Many people are debilitated by their cough. They report that their friends and family do not want to be around them because their cough is so disturbing or because they fear the spread of infection.