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Chronic Cough
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Chronic Cough

I had been treated for asthma for about 25 years.  I saw a new pulmonary doctor this fall who performed a methacholine challenge and the results showed that I do not have asthma, but instead have vocal cord dysfunction.  The doctor had me stop all of my asthma medications and I did fine for about 3 weeks.  Then I started having an almost uncontrollable cough which was worse at night and produced a large amount of phlem and boughts of shortness of breath.  I went through several tests, including a Bravo test and was diagnosed with reflux that comes up to my vocal cords which they believe is contributing to the cough and causing shortness of breath.  I have had these symptoms for over 4 months and have been taking Nexium.  I recently got fed up with the shortness of breath and put myself back on my Pulmicort inhaler.  The inhaler has reduced my symptoms (although they are not gone), however when I talk to my doctor about it she believes the medicine (Pulmicort)  will only improve asthma symptoms, and since I do not have asthma, she doesn't think the Pulmicort could possibly be treating my VCD.  She suggests that I have a fundoplication to stop the reflux, but I hate to have surgery if there is something else going on.  Have you ever heard of inhaled steroids, such as Pulimcort helping VCD?
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One can simultaneously have asthma, vocal cord dysfunction (VCD) and reflux.  Reflux can contribute to both asthma and VCD.  You should try to get more information about the results of the methacholine challenge – specifically, with how much certainty was your doctor able to rule out the diagnosis of asthma on the basis of the test results?

Also, it is conceivable that you could have recurrent aspiration of gastric contents that could precipitate VCD and bronchospasm with airway inflammation, in the absence of intrinsic asthma.  In that case the "asthma relief" from Pulmicort Turbuhaler® (budesonide inhalation powder), could be on the basis of a reduction of the aspiration airway inflammation.  This explanation could also apply to benefit from the Pulmicort Turbuhaler® (budesonide inhalation powder) in treating VCD; i.e. reduced vocal cord inflammation from the Pulmicort Turbuhaler® (budesonide inhalation powder) and with reduced vocal cord inflammation, a reduction of frequency of active VCD.

It sounds like you have severe gastroesophageal reflux disease (GERD).  If it truly is as bad as described, while on optimum medicine and the implementation of conservative measures to reduce reflux, you may well have to give serious consideration to a fundoplication.
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