The Chronic Cough Enigma

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.


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.

Laryngopharyngeal reflux Posterior laryngeal inflammation (reflux laryngitis)
Stimulation of supraglottic laryngeal receptors
Endolaryngeal aspiration of gastric contents
Gastroesophageal reflux disease Stimulation of vagal receptors by the refluxate
Stimulation of esophageal stretch receptors
(e.g., Eructation, bolus of the refluxate)
Tracheobronchial aspiration of gastric contents
Upper respiratory infection Acute inflammation of the laryngopharynx
Laryngeal/vagal neuropathy Acute neuropathy due to viral inflammation
Post-viral vagal neuropathy Aberrant neural regeneration following viral neuropathy; “hyperirritable vagus syndrome”