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    Suggest treatment for persistent cough

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Posted on Mon, 20 Jun 2016 in Ear, Nose and Throat Problems
Question: Hello Doctor
I have Persistant cough since last 4 months.

I started using new BP medication since Dec last week. My (mostly wet)cough almost started from XXXXXXX first week. I had a wet cough very often and was not able to sleep well because of cough. My throat is itchey.

In feb, I visited doctor because of Cough. Doctor suggested to change the BP Medication assuming that Cough might be caused because of the BP Medication. Even after stopping the Medication, Cough did not go away.

In March I had virual infection(because of weather change, most people here got virual). I had gone to different doctor. They took chest X-ray and I was told that chest Xray looks good. He prescribed me with Anti-biotic. Fever came down next day but cough still continued.

Somewhere in Feb/March, Cough changed to Dry cough completely. with Doctor suggestion I started using Zantac(for acid reflux). and after few days I started using Benedryl. At some point coughing went little down but I was having atleast few times cough.


Yesterday I had seen different doctor. Doctor suspected it could be because of Acid Reflux and prescribed OMEPRAZOLE DR 40 MG.

I stopped Benedryl and I started using omeprazole since yesterday. Suddenly my cough symptoms got changed. There is no Itchey throat but wet cough started with little mucus.

Can you please suggest what could be causing persistant/Chronic cough?


if you would like to look, I can get the Xray images.


Thanks so much.
doctor
Answered by Dr. Naveen Kumar 9 hours later
Brief Answer:
Could be either sinus related or reflux induced cough...

Detailed Answer:
Hi XXXXXXX

Thanks for posting the query

Persistent cough could be due to various causes. To mention a few:
1. Recurrent nasal/sinus block
2. Allergic airway disease
3. Acid reflux disease
4. Medicines such as ACE inhibitors taken for hypertension
5. Recurrent sore throat, etc.

In your condition, most of the causes have been ruled out, including the chest related issues. So, the most probable cause could be either sinus related or laryngo-pharyngeal reflux secondary to acid reflux disease.

As you are already on proton pump inhibitors, the best medicine for reflux induced cough is Lansoperazole and not Omeprazole. Hence, you can request your doctor for the change of medicine. Secondly, you would also require a prokinetic to prevent the reflux and an antacid to neutralize the acid in the stomach. The combination of these medicines can help in relieving the cough and expectoration.

Get an X-ray of the paranasal sinuses also to rule out any sinus inflammation.

Follow home remedies such as, drinking plenty of warm water and doing steam inhalation. Avoid chilled food and beverages, spicy food, oily food and fizzy drinks.

Hope this answers your query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Naveen Kumar 40 hours later
Dr XXXXXXX
Thanks so much for the clarifications.

I have 2 more questions..

1. OMEPRAZOLE DR 40 MG. : Is it more powerful? Doctor was in dilema whether to prescribe 20MG or 40 MG. finally he prescribed OMEPRAZOLE DR 40 MG. Please suggest if I can continue taking this tablet or do you suggest me to get 20Mg. FYI: I am 40 year male 175 Lbs weight.

2. Chest Xray: I was taken the chest X-ray. Does chest X-ray confirms if there is no Viral or Bacterial infection. Does Chest X-ray also confirms if there is TB ?

Thank you so much

doctor
Answered by Dr. Naveen Kumar 9 hours later
Brief Answer:
Lansoperazole is the drug of choice for reflux induced cough...

Detailed Answer:
Hi

Thanks for writing back

The drug of choice for reflux induced cough is Lansoperazole. But, there is no harm in using Omeprazole.

The doctor can start with initial dose of 40mg twice or once in a day. Later, after a week, the dose can be reduced to 40mg once a day. Adding a prokinetic will definitely make a difference.

Chest TB can be identified by x-ray. But, cofirmation has to be done by certain blood tests such as Interferon Gamma Release Assays (IGRAs).

Hope this answers your queries. Wish you good health.

Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Naveen Kumar

ENT Specialist

Practicing since :2001

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