Dr. Denis Grillo, Ear, Nose & Throat, 10/09/12

Coughing can be an annoyance, or it can be a signal of a life-threatening disease.

As we know from history, it can be a vector for disease, passing on tuberculosis from individual to individual and pertussis or whooping cough — which, interestingly enough, we thought was on a downward path to extinction but in the past few years has seen an increase that we think may be related to decreased immunity years after immunization and young children not getting immunized.

Physicians describe coughing as acute, less than three weeks, subacute lasting three to eight weeks and chronic if it is longer than eight weeks. As you might expect, the acute cough related to an upper respiratory infection is the most common cause.

Nonetheless, and even if it is self-limiting, coughing sends patients to the pharmacy, and we spend upward of $3 billion annually for medications to suppress the cough. Doctor visits as a result of coughing is the No. 3 leading reason to visit your physician. Some estimates put office visits for coughing up to 30 million visits a year.

Most of the time, coughing is easy to recognize, diagnose and treat. But sometimes it can be challenging. Not only do upper respiratory infections cause coughing, but coughing can be related to other entities, for example, nasal problems including allergies, sinusitis, and nonallergic rhinitis can cause coughing, as well as lung problems — asthma and cigarette smoking top the list.

Esophageal and gastric problems, such as heartburn and reflux, are one of the most common causes of coughing.

The mechanism is that fluid and/or food products regurgitate from the esophagus into the throat and cause and trigger a cough.

Cystic fibrosis is a genetic disorder that also can cause chronic coughing. Systemic diseases such as hypertension, high blood pressure, heart or cardiovascular disease and even certain blood pressure pills can cause coughing.

Neurologic problems, such as vocal cord paralysis secondary to an injury or stroke, can cause a patient to cough.

Tumors in the throat — associated with throat cancer, lung cancer and esophageal cancer — likewise can cause a cough, as well as large thyroid tumors.

Some common non-serious triggers for chronic cough include habitual, secondary to anxiety or nervousness, clearing of the throat, talking too much, laughing out loud, singing, swallowing, yawning, breathing in cold air and touching specific spots on the neck.

Identification — diagnosis is the key to treatment and ENT doctors are sometimes involved in the diagnosis of chronic coughing, along with our primary care colleagues, but the role is also open for our lung specialists, allergists, stomach doctors, cardiologists, infectious disease specialists, as well as our neurology colleagues to sometimes assist in identifying the cause and implementing treatment.

So, as you can see, coughing can be very simple, spontaneous onset, short-lived and spontaneous resolution or it can be a protracted process that might necessitate a visit with your doctor.

Denis Grillo, D.O., FOCOO, is an ear, nose and throat specialist in Crystal River. Call him at 352-795-0011 or visit CrystalCommunityENT.com.