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Suffering from irritation at throat and dry cough. Not cured by medicine. What should I do?

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ENT Specialist
Practicing since : 1991
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I am suffering from irritation at throat and dry cough since 15 to 20 years, the time I had started taking pills for BP. I have changed 3 doctors. Now a days the frequency of cough increased. I have slight pain like feeling on my left abdomen. While coughing the same place expands or bents. Recently five months back I have done AEC test which counted 1.1 thou/mm3. Also done test 5 month back IMMUNOGLOBULIN IgE,SERUM(FEIA) which counted 2743 kUA/L. In Glucose, fasting it was 130 mg/dL and pp 124. Doctor advised Setapin 500, Zentel400 and Alerfix Total. After taking the medicine for 2 months I did not go to the hospital due to the work schedule. Visited doctor (senior Doctor this time)on 12th oct who prescribed Foracort200 inhaler and Salbair- I,Cetapin XR 1 g, Alerfix M. I consulted the doctor as advised after ten days with a new test report of AEC which is 1.00 thou/mm3 and NCCT-PNS (CT PNS Axial & Coronals (Plain). He added Duonase nasal spray and advised to consult after one month after showing the NCCT-PNR test scan report to an ENT specialist.If this report is required I will provide as you advise.

My BP is controlled with medicine. I am 65 years old entrepreneur in Delhi. Daily I take 3-4 pegs of whiskey after 9 PM at home. I am a non vegitarian. Was doing excercise regularly. Because of knee pain it has been discontinued.

With Regards,
Posted Sun, 2 Dec 2012 in Asthma and Allergy
Answered by Dr. Sumit Bhatti 3 hours later

Thank you for your query.

1. With the above set of symptoms and test results, you first need to rule out Churg Strauss Syndrome or a similar vasculitis syndrome. Discuss this with your physicians.

2. You may share the images of your CT PNS and any Chest X-rays for an accurate assessment.

3. Get your XXXXXXX (Anti Nuclear Antibody), c-ANCA and p-ANCA (Anti Neutrophil Cytoplasmic Antibody) levels tested.

4. Anti hypertensive medication may also cause persistent cough. Which BP medicine are you taking at present?

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Above answer was peer-reviewed by
Follow-up: Suffering from irritation at throat and dry cough. Not cured by medicine. What should I do? 22 hours later
Hi Dr. XXXXXXX Bhatti,

Thank you very much for your valued feedback. The Doctor to whom I consulted who had prescribed for HT was confidently telling the medication was not causing cough. The medicines are Amlopress AT and Natrilix SR for morning and Covance-50 for night.
Recently the medicine has been replaced by new doctor. Covance-50 (morning & night), Amlopress-5 (morning).
As I am not able to send images of CT PNS and X-ray through mail, I am sending the Investigation/test results. The XXXXXXX c-ANA and pANCA tests will be done later on after getting further diagnosis advises.
Investigation of X-ray-Chest PA/AP View Results Dated 04.05.2012
No focal lesion seen in the lung parenchyma...CP angles and domes of the diaphragm are normal...Mild broncho vascular prominence is seen...Cardiac size and configuration is normal...Trachea is central; no mediastinal shift is seen...Marginal thoracic osteophytes are seen.
IMPRESSION: Mild broncho vascular prominence...Marginal thoracic osteophytes.
Advice: Clinical Correlation.

Investigation of NCCT PNS (Coronal/Axial) Dated 30.10.2012
3mm contiguous scans of the paranasal sinus were obtained in the coronal/axial plane on a multislice scanner
Bilateral polypoid maxillary mucosal thickening is seen...The right osteomeatal complex is obliterated. The left osteomeatal infundibulum is obliterated...Polypoid ethmoid mucosal thickening is seen...The left middle turbinate is only party delineable. Polypoid soft tissue is seen in the left nasal cavity, in the region of the middle meatus and abutting the inferior nasal turbinate...Polypoid right nasal mucosal thickening is seen with poor delineation of the right middle turbinate...The nasal septum is deviated towards the left...Focal bony defect is seen in the medial wall of bony maxillary sinuses...The nasolacrimal duct on either side is normal...The lamina papyracea on either side is normal...The pterygopalatine fossa on either side is normal.
Advise: Clinical correlation.

Some other test reports are done recently.(Out of range or near to maximum range is given)

Lever function Test Profile
Albumin                    3.4 g/dl
A.G Ratio                1.0 g/dl
Gamma Glutamyl Transferase     106 IU/L

CBC Test
RBC Count               4.37 10~12/L
Eosinophils               14 %

Renal Profile
Sodium                    132.0 mmol/L
Chloride                    99.0 mmol/L
Specific Gravity               1.010

Ultrasound Whole Abdomen
Liver is mildly enlarged in size measuring ~16.5cm with increased parenchymal echogenecity suggestive of fatty liver grade I. No focal lesion is seen...No intra hepatic biliary radical dilation seen...Gall bladder is well distended and is normal ...Portal vein and CBD are not dilated...Pancreas is normal in size, shape and echogenecity...Spleen is normal in size, shape and echogenecity...No retroperitoneal lymphadenopathy seen...Bilateral kidneys are normal in size, shape and echogenecity. No focal lesion or calculus seen. Bilateral pelvicalyceal systems are not dilated...Urinary bladder is normal in shape, outline and distension. Lumen is anechoic and no wall thickening seen...The prostate is normal in size, shape and echopattern...No free fluid is seen in the abdomen/pelvis.

X-Ray both knees(standing)AP & Lateral
Bilateral Patellar and tibial spiking is seen...Marginal tibio-femoral osteophytes are seen...The petello-femoral joints space is reduced bilaterally...The lateral tibio-femoral joint space is reduced...No soft tissue abnormally is seen.
Is the pain on knee because of allergy or arthritis? Can you please recommend for operation if it is arthritis? Occasionally the pain increases at left knee. It is controlled by Cap. Nimulid and orthopaedic heating pad. Is the left abdominal pain at one point causing any problems? Is it gas trouble? Gas problems are there. Ultrasound had done only for this pain. The doctor told not to worry.

I belong to Kerala and settled in Delhi since 42 years and am a non-smoker since 15 years. I worked in Ferrite dust area (but controlled) for 15 years. Now too my establishment is engaged in dust releasing grinding works which of course controlled with water, though I am sitting in separate room.

Thanks & Regards,
Answered by Dr. Sumit Bhatti 7 hours later

Thank you for your query.

1. Anti-hypertensive medication can cause cough. The mechanism is unknown. You should take a trial with change of the mediation.

2. Your chest X-ray is fairly normal.

3. Your CT PNS report mentions sinusitis with ployp / polypoid nasal mucosa. Initial treatment should be medical.

4. Your serum proteins and A:G Ratio is low. GGT is raised due to fatty liver. Eosinophil count is high. Serum electrolytes are low.

5. To differentiate between allergy and arthritis, you need to get the XXXXXXX C-ANCA, p-ANCA, ESR, Uric acid CRP, RF tests done.

6. Since your USG Abdomen is normal; showing fatty liver changes, the pain is most probably gas and indigestion related. Take a probiotic such as Vibact or Providac.

7. What type of Ferrite dust have you been exposed to?

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

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