Dr. Toshi Is In! "Could I Have Pneumonia?"

Dear Dr. Toshi,

I've had a cough for over three weeks. Could I have pneumonia?

Coughing is one of the most common reasons why patients go see their healthcare provider. A cough can be categorized as acute (new) or chronic (going on for a while), and there are many different causes of coughing. So, today, I will discuss some of the most common causes of a cough.

An acute cough for adults is defined as a cough that has been going on for less than three weeks. A very common reason for an acute cough is an upper respiratory infection (URI) such as a common cold. (A cough from a viral URI can last up to six weeks!) Other possible causes of acute cough include exacerbation (a worsening condition, or an attack) of a chronic lung disease such as COPD (Chronic Obstructive Pulmonary Disease, such as emphysema), irritation in the throat, blood clots in the lungs, or as in the question today, pneumonia deep in the lungs.

A cough lasting longer than three weeks is called a chronic cough. Common causes of a chronic cough in adults include "upper airway cough syndrome" (the new medical term for "postnasal drip"), asthma, and GERD (gastroesophageal reflux, also known as "acid reflux"). For children, GERD is not very common, but asthma is. Other causes include foreign objects in the throat and other types of lung diseases such as cancer, but they aren't as common. Stress can even be a cause of a chronic cough!

You may have been asked by your doctor or other provider if you have postnasal drip ("upper airway cough syndrome") when you had a cough. Postnasal drip can cause coughing, but interestingly, patients may not notice that they have post nasal drip because it's "silent." Asthma can also cause persistent coughing in adults, and that's actually very common for children. People with asthma can have other symptoms like wheezing and shortness of breath, but there is something called a "cough variant asthma" in which coughing is the only symptom.

Gastroesophageal reflux (GERD) is thought to be the second or third most common cause of persistent coughing among adults. Many people who have this also say that they have heartburn or a sour taste in their mouths, but more than 40% of people who have a cough due to GERD don't have those symptoms.

Another common cause of coughing among adults is a type of medication called an ACE inhibitor which is used to lower your blood pressure. One very common ACE inhibitor is lisinopril. For people who get a cough from an ACE inhibitor, the cough usually begins within a week or two of when they start taking it, but it can start up to six months later. It can cause a tickling, scratchy or itchy sensation in the throat, but the cough usually goes away within a few days of when a patient stops taking it, though it can take up to one month for the cough to go away.

There are many, many other causes of a chronic cough, and some of them are serious, so if you've had a cough for a while, you shouldn't just ignore it. One interesting cause of a chronic cough, and you may even know someone who has it, is called, "oto-respiratory reflex," also known as an "ear-cough." People who get irritation in their ear canal from a foreign body such as a Q-tip, ear bud, or ear wax can experience a really bad, persistent dry cough. I once had a patient many years ago with this condition who literally couldn't stop coughing and was in tears because of it. We cleaned her ears, and all of a sudden, her cough completely stopped! It was really dramatic!

Coughing can also cause complications such as fatigue, insomnia, headaches, urinary incontinence, hoarseness, and even broken ribs! Although you may think you know the cause of your cough, if you're concerned or not sure, or if there is a major change in your cough from your regular type of cough, please see your doctor or other medical provider.

Dr. Toshiko ("Toshi") Luckow, MD, is a Family Physician at the West River Health Services Hospital and Clinics.