What is this cough

My 30 year old husband has a chronic cough of several weeks duration.  The funny thing is, it gets better when he lies down and is very bad when he is upright.  He coughs up much mucus when he is upright and often ends up vomiting due to the coughing.  This happens 3 or 4 times a day or whenever he is upright.  He does suffer from asthma but this has been controlled using a preventer inhaler and one inhaler for emergency use.  Neither have any effect on this cough.  He hasn't been able to keep any food down for days unless we figure out a way to feed him lying down.  We go through 300-400 tissues a week due to the mucus and nasal discharge he has.  I have tried anti-histamines, sudafed, mentholated cough syrup.  You name it we have tried it.  His chest is clear, as our doctor recently confirmed.  He says he gets an irritation in his throat about where his neck attaches to his chest.  What could this cough be.  Why does it get better when he lies down and so very bad when he is upright.  What can he do to stop this cough and return some normalcy into his life.

[Victoireh]

There are a few possibilities for his cough, and he should get tested for them, so that he may get the right treatment. One is he could have GERD, which presents atypically with only a cough. This happens when the stomach contents go straight up to the esophagus and actually reaches the voice box. The damage can be seen on the larynx. The treatment for this form is more aggressive then for the standard hurt burn type people. A gastrologist can look at this area with a scope and determine if there is anything going on. Also a pH test with paper inserted into the esophagus is considered the gold standard for GERD.

The second reason for his cough is sinusitis. If his sinuses are chronically infected all of the time, as suggested by his current post nasal drip, then taking all the over the counter meds will do him no good. He should have a CT scan done on his sinuses and even then it won't necessarily reveal well what is going on in the sinuses. A good ENT specialist with the latest technology in scopes (camera with fibre optic cabling provides the best pictures) will be able to pick up chronic infections. I've had experience with chronic sinusitis that wasn't properly diagnosed till surgery was performed believe it or not!

I would certainly persist on this as it is affecting his quality of life, and with the right treatment he should feel much better.