When is an Xray needed?

I have been coughing for 3 weeks now.  Sudden onset in the middle of the morning at 2 am.  Like I had swallowed down the wrong tube, however it wouldn't stop.  It was as if I was suddenly drowning.  I went to ER.  They said I choked or had bronchitis and sent me home after a brief lung treatment and prescription for cough in pill form.  It didnt work by the way.  A week later I still had a bad cough and the fires were going full force and I work at the base of the Old fire.  The smoke was really bothering me.  My doctor gave me liquid cough syrup and that has helped.  Now 3 weeks later, I am still coughing and feel very tired and have a low grade temp and sometimes feel a little nauseated.  My back hurts, my chest hurts and I feel really sick.  I have been trying to work through all of this but today I stayed home.  Last night I went to my HMO and they said they didn't hear any sounds in the steth and sent me home with ERY-TAB 250 and no Xray.  I feel like they should of done an Xray, when is an Xray needed?

[Kevin Pho, MD]

There are several reasons for chronic cough.  The first thing to rule out would be an infection.  If it has been going on for 3 weeks, it would certainly be reasonable to take an X-ray.  

If the X-ray is negative and the cough continues despite antibiotics, then other causes should be considered.  There are a class of antihypertensives known as Ace-inhibitors that can cause chronic cough.

Other causes include GERD, post-nasal drip, and asthma.  They can be evaluated by an upper GI series/24-hr pH study, sinus films, and pulmonary function tests respectively.  

If you are not satisfied with the treatment, you may want to consider a second opinion.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.