Cough occurs more than thought

Dear Dr. Roach: I picked up a cough while traveling in Europe almost two years ago. No other symptoms have ever presented. Since that time, I have received every test imaginable, including spirometry, multiple breathing tests, CT scans, Xrays and most recently a bronchoscopy. Nothing was discovered through any of these tests. Other than the cough, I am very healthy. The cough is driving me crazy, however. I don’t know where to go from here, but I know I can’t live my life with this cough. I avoid a lot of personal interaction because it is so disruptive to constantly be coughing. — P.M.

Chronic cough (lasting more than several months) is most frequently a result of acid reflux, asthma or postnasal drip, although there are many more causes, including infection, which would be a concern given that you have a clear idea of when it started.

It is not that uncommon that people are left with no explanation but with a persistent cough. There are other, lesscommon treatments.

The first is the medication gabapentin (Neurontin). This is used for a condition called laryngeal neuropathy. People have written saying that their doctor prescribed the medication for them after reading it in the column and they also had relief.

A second has been a cough suppressant. Cautious use of tramadol in selected patients has been successful in reducing, but not eliminating, cough.

Just yesterday in the clinic, one of the residents I supervise had a patient with chronic cough who had dramatic improvement through the use of speech therapy. Looking it up today, I find trials showing significant improvement, if modest, with this approach. Given the potential side effects of gabapentin and tramadol, I think I will be making more referrals