Irwin has also studied the lifestyle destruction left in the wake of a chronic cough. Studies show that many people with chronic cough suffer for four years on average before getting successful treatment.
"Cough can be devastating to a person's quality of life," he says. He's known sufferers to quit school, lose jobs or get divorced because of a persistent, hacking cough.
"That's why we need to get the message out to the public that if the right [doctor] is taking care of you -- following cough management protocols that have been developed according to the best available evidence -- people have a very good chance of having their cough improved or cured."
Cough treatment guidelines for the American College of Chest Physicians were released in 1998 and will be published with revisions next month in the journal Chest. The updated guidelines will have more information on treating cough in children, says Irwin, who helped create the guidelines.
The report, he says, "will cover in detail not only everything you want to know about cough in adults, it covers in a robust way pediatric cough."
Likewise the American Academy of Allergy, Asthma and Immunology has formed a task force on cough to educate members on the best treatment approaches and to reach out to patients who need help. Some of its projects include creating brochures for the public and improving physician education, including adding more questions on cough to doctors' board examinations.
"We want to treat patients in the most cost-effective way," says Dr. Pramod Kelkar, chairman of the task force and a Minneapolis allergist and immunologist. "If you order all the tests in the world, you will find something. But that isn't cost-effective."
A simplified, cost-effective approach to cough is the goal of cough centers as well. Levine says he looks for the most common causes and treats the patient or sends him or her to an appropriate specialist if the problem is more serious -- for example, if lung cancer is suspected.
Given the proper work-up, coughs are curable in at least 90% of cases.
"It's a new direction in healthcare based on a symptom," he says. "This is more cost-effective and it's a way to coordinate all of the various subspecialties."
Gharabeigie finally found relief with two inhaled medications prescribed by Levine.
The cough was due to allergies and an acute sensitivity to particles, odors, temperature changes and certain foods. Now he's happy -- and so are his co-workers.
"Everyone around me was getting so annoyed with my coughing. But the lady next to me said, 'You're not coughing anymore,' " Gharabeigie says.
"And now I eat ice cream. Nothing triggers my cough."
(BEGIN TEXT OF INFOBOX)
A symptom with many causes
Chronic cough can be triggered by several illnesses, and successful treatment relies on pinpointing the cause. Specialists are trained to look for both the obvious and the more complex explanations.
Assessing a cough
* When has a cough gone on too long?
An acute cough lasts less than three weeks and usually serves a purpose, such as clearing mucus from the airways after a cold or flu. A chronic cough is defined as a cough that has persisted for eight weeks or more. It usually is of no benefit, and a doctor should be consulted.
* What are the causes of chronic cough?
Chronic cough is most often due to asthma, allergies, sinusitis, rhinitis and gastroesophageal reflux disease. It can also be caused by lung cancer or other lung diseases, pertussis, ACE inhibitors, bronchitis or habit. In an estimated 5% of cases, doctors cannot find a cause. Researchers are studying ways to help these sufferers.
* How do you find a doctor who treats cough?
Many pulmonologists, allergy and immunology doctors, and ear, nose and throat doctors treat cough. Guidelines for all doctors on how to treat cough are available from the American Academy of Chest Physicians (www.chestnet.org). Cough clinics can sometimes be found at university medical centers. Cough clinics usually coordinate care among several medical specialties.
-- Shari Roan