Ask A Really Smart Doctor: Why Do I Keep Coughing?

From asthma to acid reflux, get the lowdown on your trickiest health questions.
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I HAVEN'T HAD A COLD IN MONTHS, SO WHY HAVE I BEEN COUGHING FOR WEEKS ON END?

Dr. Nicholas: It could be a sinus infection or allergies. And if you have swelling and inflammation in your sinuses, it can cause postnasal drip, which irritates your bronchial tubes and becomes a form of asthma.

BUT WHAT IF I DON'T HAVE A RUNNY NOSE?

Dr. Nicholas: Your cough could be acid reflux, which happens when digestive acid backs up from your stomach into your esophagus. It's very common. Do you have heartburn after eating? Do you burp a lot? Do you cough more when you lie down? Your doctor might have you take antacids and make some changes to your diet and see if it gets better.

WHAT'S THE WORST-CASE SCENARIO?

Dr. Rachelefsky: Well, a persistent cough, especially if you're coughing up even a little blood, can be an early sign of lung cancer, but it's far more likely that it's allergies, sinus problems, or asthma. Almost twice as many adult women have asthma as men in this country -- nearly 12 million.

WHY IS THE ASTHMA RATE SO HIGH IN WOMEN?

Dr. Nicholas: Changing estrogen levels can lead to inflammation, which can bring on asthma symptoms. Also, some women spend more time at home, where they're exposed to allergens and irritants, such as pets or aerosol cleaning products.

Dr. Rachelefsky: A lot of women have increased asthma symptoms around the time they menstruate. Pregnancy can affect asthma, too -- for some women the asthma totally goes away, for about one-third it gets worse, and for one-third it gets better. And many women have fewer asthma problems when they're breast-feeding.

I DIDN'T HAVE ASTHMA WHEN I WAS A KID. WHY WOULD I GET IT NOW?

Dr. Rachelefsky: We don't really know why so many women in their 40s and 50s develop asthma. Many have had chronic sinus problems. Obesity is a risk factor in women, too. Then, once you have asthma, certain triggers make symptoms worse. They include allergies, cigarette smoke, pollution, weather changes, acid reflux, obstructive sleep apnea, and, for some, exercising. Stress and anxiety can intensify the symptoms, too, and women have been shown to develop anxiety about twice as much as men do.

I THOUGHT ASTHMA JUST MEANT THAT YOU COULDN'T BREATHE.

Dr. Nicholas: When your airways swell and get narrow, that can produce a whole spectrum of symptoms, from minor to severe. You might have a mild cough and that's it. Or you may start wheezing, or you could even have chest pain and be so short of breath that you can barely walk or talk.

Dr. Rachelefsky: Also, when you have asthma, the main problem is getting air out. If you only have trouble breathing in, it's probably not asthma.

SO IF I'M DIAGNOSED WITH ASTHMA, THEN WHAT?

Dr. Rachelefsky: There are better formulations, devices, and propellants now to deliver medications. These new inhalers get the medicine all the way down to the bottom of the lungs, where they're needed.

Dr. Nicholas: Preventive and emergency medications can keep asthma under control, but you also have to figure out your triggers and change your lifestyle. As with any chronic disease, taking your meds as directed, eating healthy foods, sleeping enough, and reducing stress are all extremely important.

MEET THE DOCTORS

Elisa Nicholas, M.D., associate professor at the University of California, Irvine, School of Medicine, and master trainer for the Physician Asthma Care Education program

Gary Rachelefsky, M.D., professor of allergy and immunology at the David Geffen School of Medicine at UCLA and a member of the LHJ Medical Advisory Board

 

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