Posted by ccf neuro M.D.* on November 11, 1997 at 00:45:21:

In Reply to: Shy Drager Syndrome - Dry Cough posted by Marie Fox on October 24, 1997 at 16:51:07:

My husband Bill has Shy Drager Syndrome/Multiple Systems Atrophy. For the
past year, he has been troubled with a dry cough, mostly at night.
Lately he has been coughing during the day also. The doctor has checked
him and says his lungs are "clear as a bell". We thought his arthritis
medicine Daypro might be causing it, because that is listed as a possible
side effect; however, after discontinuing it, he still has the cough. It
is not only annoying at night but causes severe problems during the day.
If he coughs while standing, he is very likely to black out. If there is
nothing handy to get him seated rapidly, I am afraid he will fall and
injure himself. His doctor prescribed Guaifenex DM S/R 2x/day, but
it has not helped. Is this a symptom of Shy Drager? I have never
seen it listed. Any suggestions?
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Marie,

An interesting question. To the best of my knowledge there is no direct association between Shy-Drager syndrome and dry cough, but it is conceivable that the two are somehow related. The most potent cogh suppressant medication known is codeine. If your husband is miserable, you may wish to ask your family doctor to prescribe some for him. If the cough is being triggered by dryness of the bronchial tubes, a humidifier in the house may help. It would be important to be sure that your husband is not aspirating small amounts of saliva due to poor oral and pharyngeal muscle control--- if he chokes when drinking thin liquids like water this might be a sign that such is occurring. A final possibility is that your husband has subclinical asthma, which can present as coughing spells but not actual wheezing until the spasm in the air tubes gets worse. I think it is reasonable at any rate to try and suppress the cough using whatever means are necessary, as prolonged coughing can result in what we call a Valsalva maneuver, which could trigger syncope (fainting) or even more dangerous reflex lowering of the blood pressure, given that such a response may be greatly exaggerated due to the body's inability to compensate for it because of the degeneration of the nerves that control the autonomic nervous system that is seen in Shy-Drager syndrome. We wish you and your husband well as you face the many challenges of a chronic and debilitating illness, and hope these suggestions may result in some benefit for this one. Good Luck.