A complaint of a dry cough that won't go away brings many of you in to the physician's office. The 3 most common causes of cough lasting more than 3 weeks in adults are: gastro esophageal reflux disease (GERD), post-nasal drip from allergies, and reactive airway disease (asthma). Many of us, however, worry that it could be something more sinister. Let me try and talk you out of worrying that your cough is really caused by one of the following illnesses:
1) Pneumonia: People in my office worry about viral, bacterial and fungal causes all of which are unlikely in the absence of other symptoms like fever, body aches, fatigue, and shortness of breath....in other words you should feel SICK.
2) Tuberculosis: Unlikely unless you also have night sweats, weight loss and fatigue but it's a good thought especially if you were just travelling in a less developed country or where I work in East Los Angeles.
3) Lung Cancer: Could be, but you should also have a history of smoking, blood tinged sputum, pain in the chest, or weight loss. Asbestos exposure would make your concerns even more valid.
4) Blood clot in the lung (pulmonary emboli): Unlikely unless you also have swelling in one of your legs (a deep venous thrombosis which would be the source of your lung clot), blood tinged sputum, or you get winded easily. A sharp pain in the chest that's worse when you take a breath in (pleuritic chest pain) would also be a good thing to worry about.
5) Pulmonary fibrosis/ Interstitial Lung Disease: Unlikely unless you have shortness of breath when you exert yourself and when you lie down at night or unexplained weight loss.
6) Mass in the upper airway: It could be, since a lesion that compresses the upper airway could give you a cough but that would be so unlucky and possibly reportable in the medical literature.
7) Foreign body in the ear: The "ear-cough" could be the cause of your cough if you have a foreign body or wax irritating the external auditory canal which leads to your cough by stimulation of the vagus nerve.
8) Sarcoidosis: Before you worry about this you should look out for chest pain, shortness of breath, skin or eye lesions and maybe even joint pain.
9) Medication side effect: This could be your issue particularly if you are on an Ace Inhibitor (Lisinopril, Enalapril, Ramipril, etc). An annoying dry cough is a very common side effect of Ace Inhibitors so ask your doctor about this.
As someone who has waves of hypochondriasis I have talked myself in to a few of these..... but kidding aside, the symptom of cough is responsible for 30 million physician visits a year in the United States, so we don't mind if you come in to see us to check it out.
- Dr O.
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