His primary care physician had referred him to Dr. Costrini for help. As the tired, mildly sick, aggravated, coughing country gentleman continued his story, it became clear that his appointment was with my pulmonary specialist-brother, Dr. Anthony Costrini. That explained the secretarial mystery of the patient not being on my schedule. In the phone booth he had looked up the first “Costrini-MD” he read and called for directions. I didn’t have the heart to say, “Sorry, Mr. Smith, you’re in the wrong office. You’ll have to cough your guts out a bit longer because you missed your appointment with my brother.” I decided to make a reasonable effort to figure out the cause of his cough.

He continued to tell me his symptoms. The cough was much worse at night, following meals, and was occasionally accompanied by heartburn. Rarely, he would cough up food particles. He had tried every cough syrup at the drug store without relief.

He had brought a recent chest x-ray for review by my brother. The film revealed that part of the stomach had migrated from the abdominal cavity up into the chest cavity (a condition known as a hiatus hernia). I was delighted – not that this poor fellow was coughing his eyebrows out of their sockets, but that I knew the cause of his cough and could fix it. Mr. Smith was suffering from chronic reflux of stomach acid into his esophagus. The acid had refluxed all the way into his lungs leading to irritation and the cough.

I discussed the problem with the patient, suggested some confirming studies, and prescribed the typically useful medical program for chronic Gastroesophageal reflux. The patient was happy with the discussion and was hopeful that he would soon be able to attend church, go to a movie, and go to work without attracting the attention currently attending his window-shattering cough.

I then broke the news to him that he had seen the wrong Dr. Costrini, that I would send my notes to my brother and arrange a follow up visit with him. The patient then asked, “Do you see your brother often”” I nodded affirmatively. “Well, Doc, since I know where to find you, I’ll keep coming here and you can fill him in at dinner.”

Cough is one of the most common reasons for doctor visits. Cough may be acute or chronic. The former is almost always caused by the common cold. Chronic cough is defined as lasting three to eight weeks or longer.

In smokers, the cause is almost always due to the harmful effects of the smoke. In non-smokers, the commonest causes are postnasal drip, asthma and acid reflux, as was the case for our Claxton cougher.

Less common causes include lung cancer, bronchitis and other inflammatory lung conditions, cough induced by medications such as some blood pressure and heart drugs.

In children the most frequent causes of chronic cough include environmental allergy, asthma, acid reflux, aspiration of foreign material into the trachea, and heart and lung diseases.

Chronic cough rarely may be caused by anxiety.

Because coughs that linger for more than a few weeks almost always have definable causes, it is not recommended that you take nonspecific over-the-counter cough suppressants for extended periods. Rather, see your doctor. He will usually be able to determine the cause and hopefully cure the problem.

First, however, you have to find his office.