Simple cough? Don't be too sure

His ordeal began 24 years ago with an upper respiratory infection. That was when George Gharabeigie began to cough.

And cough and cough.

"At first it was sporadic," says the Irvine man, 59. "But then any time I ate ice cream or had a can of soda, I had uncontrollable coughing. If I had a cold, I would cough and cough. Sometimes it was so bad that, at the end of the day, I had a headache and my chest muscles were sore and ached."

Over the years, Gharabeigie saw dozens of doctors about his hacking. But the cough persisted.

Experts say that's not unusual. Cough accounts for an estimated 23 million doctor visits annually, making it the No. 1 reason people see a physician. But even though a cough can take a physical and personal toll, until recently many doctors failed to see it as anything more than the vestige of a recent illness. Nor were they sure how best to diagnose and treat it.

Now, however, cough specialists are crafting treatment guidelines for chronic cough. Research is homing in on the many causes, and two cough specialists recently began publishing an online journal (appropriately named Cough) devoted to the topic. Perhaps most visibly, cough clinics are springing up around the nation, typically at university medical centers. One opened this year in Mission Viejo.

"For years there were very few of us working in this area," says Dr. Richard S. Irwin, a professor of medicine and nursing at the University of Massachusetts who pioneered the concept of cough clinics. "It seems all of a sudden it's becoming a hot area of research."

But to benefit, patients often must find their way to a doctor who specializes in cough, says Dr. Kaiser Lim, a pulmonologist who studies cough at the Mayo Clinic in Rochester, Minn.

"Cough crosses so many disciplines," Lim says, "and [nonspecialist] doctors usually aren't cross-trained in allergy, immunology, pulmonary medicine and gastroenterology."

Like with other symptoms for which there can be many causes -- pain, for instance -- it's not always apparent what is triggering a cough. The most common causes are allergies, asthma, sinusitis, rhinitis and gastroesophageal reflux disease.

Some people may not suspect that their cough is due to asthma, for instance, because they don't have wheezing and shortness of breath. Likewise, cough can be linked to reflux, in which the contents of the stomach back up into the esophagus, even without the classic symptoms of heartburn and regurgitation.