"Chronic (>8 weeks) cough is one of the most common symptoms for which a person seeks medical attention. Unfortunately, many patients fail to receive an accurate diagnosis and effective treatment. That’s because people with chronic cough often have a non-pulmonary cough, that is, a problem in the lungs is not the cause of the cough. Regrettably, few physicians know much about silent reflux and neurogenic cough, the most common causes of non-pulmonary chronic cough. Those diagnoses are the focus of my work."
I am not a pulmonologist (lung doctor) but I do know about non-pulmonary chronic cough; many of my patients have it. (Non-pulmonary means that a problem in the lungs is NOT the underlying cause of the cough.) The table below shows what I find to be the most common diagnoses.
TABLE: TOP TEN CAUSES OF NON-PULMONARY CHRONIC COUGH
1. Airway reflux, aka laryngopharyngeal reflux (LPR), extraesophageal reflux
2. Neurogenic cough (e.g., post-viral vagal neuropathy)
3. Asthma / Allergy / Sinusitis / Post-nasal drip
4. Aspiration due to glottal insufficiency (paralysis)
5. Angiotensin converting enzyme (ACE) inhibitors
6. Zenker’s or distal esophageal diverticulum
7. Esophageal achalasia
8. Tracheoesophageal fistula
9. Occult bronchial foreign body
10. Trachebronchial (e.g., carcinoid) tumor
Reflux-related and neurogenic cough are the most common causes of non-pulmonary chronic cough. CLICK HERE TO TAKE THE QUIZ . If the R:N ratio is 10:0, 9:1, or 8:2, you have reflux-related cough. If your R:N ratio is 0:10. 1:9, or 2:8, you have a neurogenic cough. Other scores, 7:3, 6:4, 5:5, 4:6, or 3:7 indicate that you have both reflux-related and neurogenic cough. See THE CHRONIC COUGH ENIGMA.