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coughing all the time
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coughing all the time

My mother is 69 and has had a chronic cough for the past two years.  Her cough seems to be worse at night.  She was originally diagnosed with Bronchitis, allergies, then Asthma, GERD and now a mild case of COPD.  She has never smoked and her medical problems followed a severe case of bronchitis that didn't seem to respond to antibiotics.  We have exhausted our resources.  Since nobody seems to have answers she has seen every pulmonologist in our area.  She is currently taking several medications (Albuterol, Spirivia, Singular, Theopolon, Advair and  Prednisone)
She has tried many others but the only thing that releaves her cough is continual dosages of prednisone. The Prednisone is requiring larger dosages and it is taking more time to get my mother stabilized once she is hospitalized.  As a result she has been on substantial dosages of Prednisone for the past two years. We are desperate to find a solution or at least a way to improve her quality of life. She is currently so depressed that she has lost all hope.  We are tired of the same old attempts that yeild the same results. Her current pulmonists keeps trying to ween her off of prednisone since the drug has so many negative side effects. The result is always the same, back to the hospital for several days of high drug dosages (Prednisone & Albuterol) until she is stabilized and able to go home and then we repeat the cycle again!  She is currently in the hospital and her doctor seems to be just as perplexed as we are as to how we might be able to stop her cough without the Prednisone that is otherwise destroying her health.  We need help!!!
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The 3 most common causes of chronic cough, in the absence of infection, are asthma, gastroesophageal reflux disease (GERD), postnasal drip from nose or sinuses and medications, in particular angiotensin-converting enzyme (ACE) inhibitors.  In older individuals, oro-pharyngeal-laryngeal dysfunction may lead to chronic aspiration that can, at times, be demonstrated by x-ray imaging studies.  After 2 years, it might be appropriate to consider repeating some of the studies used to diagnose GERD with or without recurrent aspiration.

The side effects of prednisone truly are worrisome but some specific causes of chronic cough, such as chronic eosinophilic bronchitis, do respond to prednisone, in fact some times only to prednisone.  Post viral neuropathic cough is not usually included in the list of causes of chronic cough.  Cough due to viral upper respiratory tract infection may be relieved with the combination of guaifenesin and codeine, but not always.  The main issue with the opioids such as morphine, diamorphine and codeine is that any potentially effective dose is usually associated with physical dependence, respiratory depression and gastrointestinal colic.

Other drugs have been tried.  In one study, patients with a negative workup for reflux, asthma or postnasal drip were treated with the anticonvulsant drug, gabapentin, 100 to 900 mg daily and symptomatic relief was achieved in 2/3 of the patients.  In another study from the Cleveland Clinic the anti-depressant drug, amitriptyline was deemed to be effective in cases of post-viral bronchitis cough and the investigators concluded that "Amitriptyline is an effective first-line therapy for cases of cough secondary to suspected post-viral vagal neuropathy (PVVN)."  Here is the full citation from the Department of Otolaryngology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. ***@****, titled “Effectiveness of amitriptyline versus cough suppressants in the treatment of chronic cough resulting from postviral vagal neuropathy” by Jeyakumar, Anita. Brickman, Todd M. Haben, Michael in Laryngoscope, 2006 December, Volume 116, Number 12, pages 2108-2112.  These treatments may be worthy of your mother's doctor's consideration.
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Since my mother has already given up 2 years of her life while doctors are waffling annd uncertain about which course of action to persue next is there any chance that she could be admitted into one of your programs that treats the whole patient rather than one symptom at a time.  I know the doctors mean well but my mother has so many different medical issues and now is experiencing chronic back pain.  This is my last resort at getting my mother the medical attention she deserves.  Even if no relief can be found I will know that we did our best to help.  Your website indicates that you guys take a different approach and I am finding that our local doctors are stuck in the same routine that may work for most but is producing the same undesirable results for my mother.

Thank you for your time and consideration,

Brenda Hearn
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