William Storms, MD, discusses chronic cough and how it might be connected to allergies. He shares the best way to discover what's triggering chronic cough and treatment options.
Bill Klaproth (Host): People spend millions of dollars on cough products, which only give temporary life, when understanding the underlying cause of a chronic cough—which commonly is due to allergies—can provide long term relief. So let’s talk about chronic cough and how it relates to allergies with Dr. Bill Storms, an allergist at Aspire Allergy and Sinus. This is Achoo, the podcast for people with allergies and sinus issues from Aspire Allergy and Sinus. I'm Bill Klaproth. Dr. Storms, let’s start with this. Why don’t people get evaluated to find the cause of their chronic cough?
William Storms MD (Guest): Well, most people think cough is just an annoyance. In my experience, they usually don’t seek medical care until somebody else sends them in—the spouse, the coworker, somebody like that. They say gee, you're coughing all the time. You're sick. People get used to it. They think it’s no big deal, unfortunately, because it can be fixed.
Host: Right. I think that’s the important point. It can be fixed. These coughs sometimes creep up on people. Like you said, they just seem to have them for years. At what point is a cough described as chronic when it’s problematic, not just something that comes with a cold or something that goes after a couple weeks. When is it chronic?
Dr. Storms: Well, the official definition of a chronic cough is eight weeks. So I see people who have had a cough for 10 years. Then there's the other person who gets a cold, let’s say, two or three times a year and they cough for two months after the cold, then it goes away, and then they get another cold. So that is a recurrent chronic cough.
Host: Got it. So for someone that has a chronic cough that has persisted for more than eight weeks, as you say. You just said you’ve seen a person that’s had a chronic cough for 10 years. So what is the most common causes of a chronic cough?
Dr. Storms: Well, there are many possible causes. Most people have more than one cause. So the first one would be allergies, pollens, animals, molds that causes nasal congestion, drainage down the throat and you cough. Second is a chronic sinus condition, which is secondary to the allergies. Again, that causes the mucus going down the throat and cough. Then lung issues such as asthma. Then the other one is acid reflux.
Host: Okay. So that’s good to know. Those are the four main things that cause a chronic cough. allergies, sinuses, asthma, and acid reflux. So let’s stick with allergies and let’s talk about that. So what is the best way to find out what’s triggering a chronic cough? Is it through an allergy test? If that’s the case, tell us a little bit about the allergy test so someone knows what to expect.
Dr. Storms: Yes. Well, if somebody comes to my cough center, we do allergy skin testing, which is little scratches on the skin. It takes about 20 minutes to read them. If you get a hive, that’s a positive reaction. Then there’s a secondary test of a small injection of the same types of things. We look for the red itchy bump as a positive test. The allergy test can also be done through the blood, but since that takes a long time we do the skin testing primarily.
Host: So that’s really the best way to find out what you're allergic to and what's causing that chronic cough. So once you determine that and whether it’s, like you just said, animals or dust mites or some kind of a grass or pollen or maple or birch or all those things, how do you generally treat that then?
Dr. Storms: Well the treatment is based on what the person’s allergic to. So it could be pills like antihistamines, it could be nasal sprays. We have different types of nasal sprays. Other types of pills. But the whole idea is to treat the cause of the cough rather than just treating with cough suppressants, with codeine and things like that. A lot of these people with allergies, if they’ve had a cough a long time, the allergies frequently affect the sinuses. So we do sinus cat scans at the office. If there's a secondary sinus inflammation then antibiotics might be necessary.
Host: You just mentioned cough medicine. When you go into the store, you see aisles and aisles of cough medicine. It’s so confusing. How do you exactly know what to use? Then cough medicine is not a long term fix, is that right?
Dr. Storms: That’s right. The cough medicine is just a suppressant. So you’ve got the old fashioned Robitussin DM and then there's 50 different generic forms of that. That’s about all you get when you go to the drug store and look over the counter with those medicines. Some of them also have antihistamines. Then if you need something stronger, you go to the doctor and you get something with codeine, but you don’t want to take that every day.
Host: Well that’s not good either. So you just mentioned the doctor. I'm wondering how much time people waste in first going to their doctor and then maybe an ENT and then maybe somewhere else before eventually seeing an allergist. So is that right? Is that the natural path that people take? What do you see?
Dr. Storms: Well, I generally see people who have been to at least four doctors. So family doctor, they get some treatment. It’s not helping. They then refer them to an ENT who then does something. That doesn’t help. Then they go to a GI doctor thinking it’s GURD. That doesn’t help. Then they go to a pulmonary doctor. The problem is these chronic cough situations have more than one cause. So you can't just treat the sinus or just treat the lungs or just treat the GURD. You have to treat all of the causes: allergy, sinus, asthma, GURD, whatever it may be. So the allergist is the person who can evaluate all those things, one stop shopping.
Host: So it sounds like what you're saying is go see an allergist first because that person will understand all the potential underlying causes. As you just mentioned, it’s a one stop shop. So go to somebody that can really understand and target that underlying cause, and then set you up with a proper prescription for treatment.
Dr. Storms: Exactly right. Then if the cough is bothering you or your family or your coworkers. Because, as I mentioned, people sort of get used to this. They accommodate to having a cough. Little tickle cough, hacking cough. The patient gets used to it, but everybody around that person is annoyed like mad. So if people are talking to you about your cough, then it’s time to go.
Host: Right. Chronic cough is so common people eventually do go see their doctor, but as we just talked about, they often get that run around and don’t really get the answers they need because they're not seeing an allergist.
Dr. Storms: Again, if they go to the primary care doctor or get pushed around to some other doctors, after a few referrals, they haven’t been fixed and they're still coughing. They figure that’s the way it is. That’s why I see people who have been coughing for two years, five years, 10 years, 20 years.
Host: That really is unfortunate because with treatment, you can get long term success. I know with shots you can virtually wipe it out and somebody can be cough free.
Dr. Storms: Yes. For people with allergies—pollens, molds, animals—there are medicines that build up immunity against the allergies. There’s two forms. One is the weekly shot and the other is the daily drops under the tongue. So we’re actually giving the person the thing they're allergic too. Start with very small amounts and we build up their immunity.
Host: So bottom line, go see your allergist, get tested, and really understand the reason that you have this cough.
Dr. Storms: Exactly, yeah. If you have a chronic cough, get tested, find the cause, get treated for that specific cause.
Host: Well, that makes sense and thank you for laying out this road map for us Dr. Storms. We appreciate your time.
Dr. Storms: Happy to do it. Thank you very much.
Host: That’s Dr. Bill Storms. To learn more or to book an appointment, please visit aspireallergy.com. That’s aspireallergy.com. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Achoo, the podcast for people with allergies and sinus, a podcast from Aspire Allergy and Sinus. I'm Bill Klaproth. Thanks for listening.
Dr. William Storms has practiced in Colorado Springs & Pueblo since 1975 and is a past Clinical Professor at the University of Colorado Health Sciences Center. He practices clinical allergy and clinical research at The William Storms Allergy Clinic in Colorado Springs, Colorado.