The International Medical Group is a multi-disciplinary medical practice that offers professional and personalised care.

Dr Bella Beraha, born in Venezuela, joined us from Miami. She is an M.D. in Internal Medicine and runs a successful medically supervised weight loss program from the clinic.

CHRONIC COUGH DIAGNOSIS — To investigate the cause of a chronic cough, your doctor will ask about your symptoms and perform a physical examination. A chest X-ray is generally recommended if your cough has persisted for 8 weeks or more.

Based upon your symptoms and examination, your doctor may recommend a trial of treatment before any further testing is performed. If you improve with treatment, no further testing will be needed. If you do not improve or your diagnosis is not clear, further testing may be recommended.

Lung function tests — If asthma is suspected but cannot be confirmed, the clinician may perform lung function tests. These measure the pattern of air flow into and out of the lungs.

Acid reflux testing — To confirm a diagnosis of acid reflux, a test called upper endoscopy may be done to look for irritation of the esophagus and to obtain a biopsy of the esophagus.

CHRONIC COUGH TREATMENT — Treatment of chronic cough aims to eliminate the underlying cause. Most of the time, each type of treatment is tried separately, one after another, instead of all at the same time. Seeing which one works best helps to figure out the underlying cause. Here are some examples of treatment choices for different causes of cough.

Postnasal drip — A cough related to postnasal drip may improve with the use of a decongestant, nasal or oral antihistamine, nasal glucocorticoid, or a nasal spray that contains ipratropium. The best treatment (or combination of treatments) depends upon your symptoms and medical history. As an example, if you have nasal allergies, medications are chosen to control allergy symptoms.

Nasal glucocorticoids — A nasal glucocorticoid such as fluticasone (Flonase®) may help to reduce postnasal drip. The usual dose is one squirt in each nostril twice per day. Other glucocorticoid nasal sprays may also be effective.

Oral antihistamines — Antihistamines that are taken as a pill, such as chlorpheniramine (Chlor-Trimeton®) or clemastine (Tavist®, Dayhist®), may also help, but can cause side effects such as drowsiness and drying of the eyes, nose, and mouth. Most of these are available over the counter. Antihistamines that are less likely to cause sleepiness, such as loratadine or cetirizine, are less likely to help with cough.

Decongestant — Pseudoephedrine is a decongestant that can improve nasal congestion. Most drugstores in the United States carry pseudoephedrine behind the counter, so you must request it from the pharmacist (a prescription is not required).

Nasal antihistamines — A prescription nasal antihistamine spray, such as azelastine (Astelin®), can relieve symptoms of post-nasal drip, congestion, and sneezing.

Nasal sprays — The nasal spray ipratropium bromide (Atrovent®, available by prescription) can relieve runny nose, postnasal drip, and sneezing.

Cough variant asthma — If your cough is due to asthma, you will be given the standard treatment for asthma, which includes an inhaled bronchodilator and inhaled glucocorticoid. These inhaled medicines act to decrease inflammation (swelling) of the airways.

Acid reflux — Cough due to acid reflux may respond to the following lifestyle changes:

Lose weight if you are overweight

Avoid substances that increase reflux, such as high fat foods, chocolate, colas, red wine, acidic juices, and excessive alcohol

Stop smoking

Avoid eating for two to three hours before lying down

Elevate the head of the bed three to four inches

In addition, you may be given a medication to slow the production of acid in your stomach, called a proton pump inhibitor. Examples of proton pump inhibitors include omeprazole (Prilosec®), esomeprazole (Nexium®), and lansoprazole (Prevacid®). It may take eight or more weeks of treatment before your cough improves. If your cough does not improve during this time, further testing may be recommended.

Cough suppression — If the cause of your cough cannot be determined and the cough persists, a medication that suppresses your cough may be recommended

Non-prescription cough medicines that contain dextromethorphan may help suppress the cough reflex.

Benzonatate (Tessalon®) is a prescription medication that may be recommended if dextromethorphan is not helpful.

Codeine and hydrocodone are prescription narcotic medications that can be added to cough syrup; these may be tried if other treatments have not been effective. However, both medications can cause you to feel sleepy and should not be used while working or driving.

Always remember if a simple cough turns into a chronic problem visit your doctor.