10 Common Myths, Misconceptions, Errors and Mistakes about Chronic Cough

Lawrence Martin, M.D., FACP, FCCP

PLEASE NOTE. This list of 10 Common Myths, Misconceptions, Errors and Mistakes about Chronic Cough should only be read in conjunction with Chronic Cough, Rhinitis and Sinusitis - a Primer for Patients, Physician Assistants, Nurse Clinicians AND Physicians. The purpose of this list is to summarize what I see as 10 things that often delay proper diagnosis and treatment of chronic cough. Note that the responsible people may be health professionals and/or patients themselves.

1. Thinking you have to 'just live with' a chronic cough, or that it is somehow 'normal.'

There is a medical cause for virtually every chronic cough, and no patient should just accept the cough unless it has been thoroughly evalutated by a physician and all measures taken to eradicate it.

2. Assuming the cough 'must come from the lungs' or is a 'lung condition'.

While many cases of chronic cough are from lung conditions, the vast majority are not. Most cases of chronic cough arise from post nasal drip, which in turn is from inflammation of the nasal passages and/or sinuses. This point is discussed extensively in Chronic Cough, Rhinitis and Sinusitis - a Primer for Patients, Physician Assistants, Nurse Clinicians AND Physicians.

3. Undertreating the condition.

Often a doctor will prescribe medicine but the patient doesn't take it, or doesn't take it for the right length of time, or in the proper dose. Some coughs require a long time before they fully respond to treatment. A corollary of this error is when the physician doesn't give 'enough' medication or undertreats the cough (e.g., some cases of chronic sinusitis require 3 weeks of antibiotics, but only a week is prescribed; sometimes the dose of steroids given for chronic sinsuitis is too low).

4. Smoking while suffering from chronic cough.

I see many patients who continue to smoke while complaining of chronic cough. Sure, they admit to being addicted, or "I just can't stop", but there is still no excuse. Smoking could either be the direct cause of chronic cough (from chronic bronchitis), or greatly retard recovery from sinusitis/rhinitis (cigarette smoke impairs clearing of mucus). I tell my patients it's like complaining of a headache while banging your head with a hammer. Duh!

5. Fear of prescribing oral steroids.

6. Using second generation antihistamines for non-allergic rhinitis.

7. Not considering dual causes of chronic cough.

8. Diagnosing GERD to the exclusion of other causes without appropriate studies

9. Not obtaining sinus CT scan or ordering just plain x-rays of sinuses.

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The Role of Sinus Imaging in the Treatment of Chronic Cough in Adults, Pratter MR, et. al. Chest 1999;116:1287-1291.

10. Not following through to resolution.

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