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What causes persistent cough?

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Posted on Tue, 15 Jul 2014
Question: I have had a bad cough for over three months now.. Doctors have tried giving me allergy medicines, albuterol, GERD medications, cough suppressants, nothing worked. I also got a chest xray, blood tests, throat swab, and nothing was found. My symptoms are; coughing all day, having coughing spasms where I cough so hard I throw up, incontinence when I have cough spasms, tightness in chest and back, headaches, in the morning when I wake up I have lots of phlegm tinged with blood. I am miserable and Doctors can't figure it out.. I cough through out the night, so I'm not sleeping well, my social and love life is not great right now, I don't have energy to do anything anymore. Please help :(
doctor
Answered by Dr. M Y Shareef (1 hour later)
Brief Answer:
More detailed investigations are warranted.

Detailed Answer:
Hi XXXX ! Good evening. I am Dr Shareef answering your query.

Even though it might be difficult to figure out what exactly is the pathology without having a detailed clinical examination of your chest, I could think of following few points which might be of some help to you when you have already tried almost all kind of medications till date:
1) In case you smoke or stay with any smoker, say absolute NO for it.
2) Avoid dusty areas and stay away from cleaning carpets,etc at home.
3) I do not know if you were checked by any ENT specialist for your chronic cough. If not, then get an appointment with an ENT specialist to rule out any nasal problem giving rise to post nasal drip resulting in severe persistent cough in the night during your sleep.
4) The tightness in chest and back could be due to bronchospasm which could occur due to any kind of allergens in the atmosphere. It could be dust, any recently started food, or any recently started perfume of any kind. If it is so, please avoid such allergens.
5) If you did not have till date, you might try a course of broad spectrum antibiotic on consultation with your doctor.
6) I would not hesitate to test your routine blood test including the CBC, ESR, Blood sugar, and an HIV test after proper counselling.
7) Try to sleep upright in your bed by positioning a back rest, or a pillows behind your back to prevent tracking of nasal secretions into the bronchial tree.
8) Many times some lesions are not detected on x-ray, and there might be the need for a CT/MRI scan and nothing is still not detected, then you might have to consult a pulmonologist for a possible bronchoscopy as a last resort for a cytological and/or histological examination of the sample so retrieved from the bronchial tree.

Till then you could go for simple steam inhalation at least three times a day, nebulisation with Budecort 1mg three times a day, an anti allergic like levocetrizine, and montelukast as a preventive drug. with these measures I am hopeful that the doctors would find a solution to your problem. At the same time, I would also suggest you to be mentally strong enough to deal with the situation and not get any kind of negative thoughts, which might be more detrimental to your health.

I hope this information would help you in discussing with your family physician/treating doctor in further management of your problem. Please do not hesitate to ask in case of any further doubts.

Thanks for choosing health care magic to clear doubts on your health problems. Wishing you an early recovery. Dr Shareef.





Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. M Y Shareef (7 minutes later)
Thank you Dr. M Y Shareef! I truly appreciate the help.

1) In case you smoke or stay with any smoker, say absolute NO for it.- I am not a smoker, ever.
2) Avoid dusty areas and stay away from cleaning carpets,etc at home.- I have no carpets at home :(
3) I do not know if you were checked by any ENT specialist for your chronic cough. If not, then get an appointment with an ENT specialist to rule out any nasal problem giving rise to post nasal drip resulting in severe persistent cough in the night during your sleep.- I failed to include the nasal medication they gave me, and I did see an ENT who put a camera through my nose and gave me GERD medications which have not worked.
4) The tightness in chest and back could be due to bronchospasm which could occur due to any kind of allergens in the atmosphere. It could be dust, any recently started food, or any recently started perfume of any kind. If it is so, please avoid such allergens.- I've tried multiple allergy medications, and I've never been allergic to anything in my life :(
5) If you did not have till date, you might try a course of broad spectrum antibiotic on consultation with your doctor.- I was on antibiotics but that didn't word.
6) I would not hesitate to test your routine blood test including the CBC, ESR, Blood sugar, and an HIV test after proper counselling.- I had blood tests done a month ago.
7) Try to sleep upright in your bed by positioning a back rest, or a pillows behind your back to prevent tracking of nasal secretions into the bronchial tree.- I will try this tonight.
8) Many times some lesions are not detected on x-ray, and there might be the need for a CT/MRI scan and nothing is still not detected, then you might have to consult a pulmonologist for a possible bronchoscopy as a last resort for a cytological and/or histological examination of the sample so retrieved from the bronchial tree.- I had a chest xray but no CT or MRI so I will mention this to the Cough Center when I go on July 3rd.

Thank you, and if you think of anything else it might be, please let me know.. Its affecting my work, and social life.
doctor
Answered by Dr. M Y Shareef (2 hours later)
Brief Answer:
Opinions of treating doctor could vary in a region

Detailed Answer:
Hi XXXX! Good to listen from you so soon.

I am not aware if cases of tuberculosis is prevalent in the region you stay or not. This is a common problem we see in this part of the continent. The cough and sputum with blood won't subside until and unless anti tubercular drugs are used. However, there are other signs for it like evening rise of temperature, loss of appetite, loss of weight and sometimes it is difficult to diagnose even when we take into consideration all together. In that case a therapeutic trial of anti tubercular drug is prescribed with full explanation/counselling and consent of the patient and many times unexpected positive results are obtained. I am not sure if this would be possible at your place, and the way doctors see the problem might vary from one region to other. So your treating doctor is the best judge to decide what is best for you.

This is not a treatment, but just for a discussion which you could initiate with your Cough Center if this pathology exists in your area. I hope this information could be of some help for you. Good luck.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. M Y Shareef

General Surgeon

Practicing since :1979

Answered : 2457 Questions

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What causes persistent cough?

Brief Answer: More detailed investigations are warranted. Detailed Answer: Hi XXXX ! Good evening. I am Dr Shareef answering your query. Even though it might be difficult to figure out what exactly is the pathology without having a detailed clinical examination of your chest, I could think of following few points which might be of some help to you when you have already tried almost all kind of medications till date: 1) In case you smoke or stay with any smoker, say absolute NO for it. 2) Avoid dusty areas and stay away from cleaning carpets,etc at home. 3) I do not know if you were checked by any ENT specialist for your chronic cough. If not, then get an appointment with an ENT specialist to rule out any nasal problem giving rise to post nasal drip resulting in severe persistent cough in the night during your sleep. 4) The tightness in chest and back could be due to bronchospasm which could occur due to any kind of allergens in the atmosphere. It could be dust, any recently started food, or any recently started perfume of any kind. If it is so, please avoid such allergens. 5) If you did not have till date, you might try a course of broad spectrum antibiotic on consultation with your doctor. 6) I would not hesitate to test your routine blood test including the CBC, ESR, Blood sugar, and an HIV test after proper counselling. 7) Try to sleep upright in your bed by positioning a back rest, or a pillows behind your back to prevent tracking of nasal secretions into the bronchial tree. 8) Many times some lesions are not detected on x-ray, and there might be the need for a CT/MRI scan and nothing is still not detected, then you might have to consult a pulmonologist for a possible bronchoscopy as a last resort for a cytological and/or histological examination of the sample so retrieved from the bronchial tree. Till then you could go for simple steam inhalation at least three times a day, nebulisation with Budecort 1mg three times a day, an anti allergic like levocetrizine, and montelukast as a preventive drug. with these measures I am hopeful that the doctors would find a solution to your problem. At the same time, I would also suggest you to be mentally strong enough to deal with the situation and not get any kind of negative thoughts, which might be more detrimental to your health. I hope this information would help you in discussing with your family physician/treating doctor in further management of your problem. Please do not hesitate to ask in case of any further doubts. Thanks for choosing health care magic to clear doubts on your health problems. Wishing you an early recovery. Dr Shareef.