Chronic cough needs investigation for a cause

Dear Dr. Roach: You once wrote a column on chronic cough and suggested a medication that might be useful in treating this.

Would you please remind me of the drug name?

I have an elderly mother who suffers daily with this affliction. She can no longer have a conversation or speak on the phone because of it; even activities of daily living are interrupted by these episodes.

We have tried a number of options. Some have worked for a while, but nothing for any length of time.

I would appreciate any info you could give me. — J.N.

Dear J.N.: Severe cough like your mother’s deserves a thorough workup, and although a regular physician can certainly handle most cases of cough, an expert is appropriate for the kind of cough that lasts for months and resists a diagnosis.

Hopefully she can see a pulmonologist, although there are causes of cough outside the lungs, including the ear/ nose/throat (postnasal drip) and stomach (acid reflux).

Some drugs, especially ACE inhibitors, are well known to cause chronic cough.

I’ve had a very few cases of people who have had exhaustive evaluations with no answer.

Some people have a neurological cause (laryngeal neuropathy), and have responded well to medication, such as gabapentin.

I’ve had the rare patient in whom nothing has worked, and have tried an opiate cough suppressant, tramadol.

This medication should not be used lightly, nor in a person with a history of substance abuse, and the ordering physician should carefully monitor treatment.