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Specialized Center at Montefiore Treats Chronic Coughers

Newly announced guidelines by the American College of Chest Physicians say that adults are better off using older nonprescription antihistamines and decongestants to stop the flow of mucus that causes cough.

But for many, the issue is not a cough caused by the common cold. The issue is a debilitating, chronic cough that causes loss of sleep and disrupts your social life.

"Chronic coughs are in a league by themselves. People put up with them for years, unnecessarily, until they become very serious psychosocial problems." said Peter Dicpinigaitis, MD, director of New York City's only specialized cough center.

"In addition to sleep loss, chronic coughs frequently lead to problems with your spouse, disrupt family life and act to discourage sufferers from undertaking the simplest of social activities, such as going to the movies," said Dr. Dicpinigaitis, who is one of the nation's few researchers to conduct ongoing clinical studies on cough.

Cough is the most common complaint for which outpatients seek medical care in the United States, according to the US Department of Health and Human Services. Most coughs can be treated by primary care physicians, and many so-called post-infectious coughs due to colds, resolve spontaneously within a couple of months. A smaller number become chronic cases and require special care.

"The three main causes of coughs are post-nasal drip, asthma and acid reflux," said Dr. Dicpinigaitis, who gets patient referrals from primary care physicians, internists, surgeons and other pulmonologists. "Coughs become chronic if the specific cause is not diagnosed, the appropriate medication is not used, or too little medication is used."

Asthmatic Coughs Cured by Correct Medication

One of Dr. Dicpinigaitis' patients is a nurse in her mid-forties who suffered for a decade with an asthma-related chronic cough. She was using an inhaler to take steroids and bronchodilators to treat her asthma; but they were not suppressing her cough. She had been to numerous other physicians about her cough and nothing they prescribed helped.

"She had what is called cough variant asthma," said Dr. Dicpinigaitis. "After diagnosing the problem, I prescribed a specific asthma medication and within a few days of taking the drug, her cough was gone. In her case, we knew the cause; it was simply a matter of adding a medication to her regimen."

Older Antihistamines Offer a New Cure for Post-Nasal Drip

Another of Dr. Dicpinigaitis' patients is an elderly woman who had been persistently coughing for a decade and had come to him because her cough had worsened in the past year. Her original physician had prescribed newer antihistamine drugs, popular because they do not cause drowsiness, to help relieve her post-nasal drip. But, the drugs were not working to relieve her cough.

Suspecting that post-nasal drip was the cause of the woman's cough, Dr. Dicpinigaitis prescribed an older antihistamine drug, a combination of chlorpheniramine and psuedoephedrine. "Within a few days her cough was gone. Although, we don't understand completely why older antihistamines work better, it may be because they act on the central nervous system to suppress the cough reflex," he said.

Acid Reflux

"Patients with acid reflux who suffer from a chronic cough are frequently the most difficult to diagnose and treat," said Dr. Dicpinigaitis. "They may have only a cough and not heartburn, so it is difficult to determine that the underlying problem is reflux." Even when the cause is determined to be reflux, finding the best treatment requires patience, says Dr. Dicpinigaitis. "Drugs known as proton pump inhibitors, prescribed to treat acid reflux, may take weeks or months to kick in," he said, "and sometimes a higher than standard dose may be required to alleviate a cough."

Gender Differences and Other Research Findings on Cough

Dr. Dicpinigaitis, who is also the director of the Intensive Care Unit at Montefiore's Weiler Hospital Division, has conducted research on different aspects of cough and has found:

There are gender differences in cough sensitivity - women have a more sensitive cough reflex than men. As a result, women are more likely to suffer the side effects, such as cough, of ACE inhibitors taken for cardiovascular disease.
Specific new asthma medications known as leukotriene receptor antagonists are particularly useful in treating cough due to asthma.
Cigarette smoking suppresses the cough reflex in men. As a result, smoking inhibits an important defense mechanism and may make smokers more prone to respiratory infections.