Cough and Nausea

[Gary E]

I am a 50 year old white male with a 15 year history of reflux (controlled with Nexium) and no other major health issues. I take Diltiazem 180 for BP and Ambien 5 to sleep. I quit smoking over 20 years quit my wine (2 -3 glasses/night) over 5 years ago.

I have had an endoscope in July 2002 which was fine. 4 weeks ago I started to feel a bronchitis type of sensation in my chest with no cough and no fever. Better when I sat still and gone during the night but returning with activity. My GP suggested a reactive airway issue and prescribed Advair 100 twice a day. Three weeks later, with no improvement in the sensation, a dry cough developed. GP prescribed Advair 500, Singulair, Combivent QID. No improvement after another week and now I have severe nausea in the morning which goes away by about noon. GP wants to go with Predisone regiment.

I have no real trouble breathing, just the sensation, though GP reports hearing some wheezing (I hear none). I am wondering whether this could be Esophageal cancer. I've heard of coughs being related as initial symptoms. Swallowing is ok except that I can feel things going down (not new)and I have some mild reflux but I feel none at night. Anxiety is high with worry and I think these medications make it worse. BP is elevated again probably for the same reason.

Also, have you ever heard of Ambien being related to reflux or coughing? I'm thinking of a connection between sleep sedation and aspiration. Thanks for your help.

[Kevin Pho, MD]

To my knowledge, ambien is not related to reflux or coughing.  

The most common reasons for chronic cough would be reactive airways disease, GERD, or post-nasal drip.  They account for 90% of chronic cough cases.  You are being appropriately treated for airway disease with the Advair, Singulair and Combivent.  

The next step would be to ensure that your reflux is appropriately controlled.  The most definitive test for this would be a 24-hr pH study.  If the reflux cannot be controlled with medications, then surgical options may be considered.  

To evaluate for post-nasal drip, you may want to consider sinus plain films and a sinus CT.  

Blood pressure medications known as ace inhibitors also cause chronic cough - but from your description, this should not be an issue.

If thost tests are negative, more specialized testing can be considered in conjunction with a pulmonologist or otolaryngologist.  

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.

[sunny_one]

My mother had something similar, but with watery eyes. She was diagnosed with Rye Eye and since using wetting drops her cough has gone away. She also takes BP medication.

I developed a dry cough during 3 months of soft stools - later diagnosed with parasitic infection. I nearly died from the 'cure', but the cough has gone away. Now taking potassium supplements.

I have found it frustrating when visiting doctors for my health issues - it seemed that they wanted to treat individual symptoms and not look at the big picture. It also seems like many docs are quick to hand out medication which can mask your symptoms without addressing the underlying problem (which they may not be able to diagnose). I was prescribed everything from beta blocker to antidepressant before finding the parasites. I'm sure I was a really difficult case, but it shows that you have to keep on top of your health or you may end up with pills that don't help. Good luck and find the best doc for yourself.