John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Chronic cough is a cough that persists. Chronic cough is not a
disease in itself; rather it is a symptom of an underlying condition. Chronic
cough is a common
problem and the reason for many doctor visits.
Some common causes of chronic cough include
allergic rhinitis, sinus
problems (for example sinus
infection), and esophageal reflux of stomach contents. In rare occasions, chronic
cough may be the result of aspiration of foreign objects into the lungs (usually
in children). It is very important to see a doctor who may order a chest
X-ray if a chronic cough is present. The following are common causes of
Asthma is a disease of airways, resulting in difficulty breathing or
wheezing often characterized by abnormal breathing tests. Some asthma sufferers
have chronic cough as their only symptom. They may even have normal lung
functions tests. This is often referred to as cough-variant asthma.
symptoms can be aggravated by cold air, exposure to air pollutants or
pollen, smoke, or perfumes.
Gastroesophageal reflux disease (GERD) refers to
acid reflux, or backward flow, of stomach acid
and other contents into the esophagus. If stomach acid moves backward up the
esophagus, reflexes result in spasm of the airways that can cause shortness of
breath and coughing. In some instances, acid reflux can be so severe that substances
can be aspirated into the lungs and cause similar symptoms as well as damage to
lung tissue. In some individuals, no sensation of heartburn is felt and their
only symptom may be cough.
Sinus problems and postnasal drip can also cause chronic cough
with mucus. This
condition can be difficult to detect. Sometimes CT scan of the sinuses is
necessary for diagnosis. Affected individuals often complain of a "tickle in
their throat" and frequent throat clearing.
Infections such as bronchitis or pneumonia can cause
acute cough or a chronic cough. These
infections can be caused by viruses, bacteria, or fungus. Viral infections do not
respond to antibiotics. In patients with asthma, viral upper respiratory
infections often result in a protracted cough even after the infection has
A particular strain of bacterial pneumonia, called Mycoplasma,
may cause a chronic cough with fatigue, weakness, shortness of breath, and
sputum production. This infection is sometimes referred to as "walking
pneumonia," and commonly affects young and relatively healthy people.
Whooping cough (pertussis) is an acute, highly contagious respiratory
infection caused by the bacterium Bordetella pertussis. Whooping
cough commonly affects infants and young children, but can be prevented by
immunization with pertussis vaccine. In adults, whooping cough can be a
cause of chronic cough.
Chronic cough in children is uncommon. Foreign material
obstructing the airways of the lungs, asthma, and allergies are evaluated by
If chronic cough persists it is extremely important for the affected
individual to be evaluated by a doctor. The doctor will consider the possibility
of asthma, postnasal drip, esophageal reflux, drug side
effect, interstitial lung disease, or other unusual infections.
Reviewed by George Schiffman, MD, FCCP on 7/12/2011
Medical Author: Melissa Stoppler, M.D.
K. Hecht, Ph.D.
Unsure about the hundreds of cold and
flu preparations on the drugstore
shelves? You're not alone. Deciding among the OTC (over-the-counter) remedies for cold,
flu, or allergy symptoms can be intimidating, and a basic
understanding of the types of drugs included in these medications can help you
make an informed choice.
Decongestants are the drugs of choice for a stuffy,
congested nose. Decongestants act by narrowing the blood vessels in the nose,
leading to decreased blood flow in the nasal tissues and reduced leakage of fluid from the
nose. Decongestants can either be taken orally or applied locally (topically) in
the form of nasal sprays or drops.
Pseudoephedrine and phenylephrine are decongestants that can be taken orally. Phenylephrine and oxymetolazone are examples of topical decongestants. While topical decongestants are effective after a few minutes, oral preparations (tablets) can take about thirty minutes to work. Decongestants
act as stimulants that can increase heart rate, raise the
exacerbate palpitations, and lead to feelings of nervousness or feeling
Esophageal pH (pH is a measure of the acidity or alkalinity of a solution) monitoring is a procedure for measuring the reflux (regurgitation or backwash) of acid from the stomach into the esophagus that"...