Non-Stop Cough

[kimberlyrkb]

I am a 41 year old, normally healthy female.  I have a persisent, non-productive cough going on 12 weeks now.  It's so non-stop that at most, I have maybe 8-10 seconds between bouts. The only relief I get is to lie down

I had this cough after the flu 8 years ago. My allergist diagnosed cough-variant asthma, despite the fact I had excellent lung function testing & passed the methylcholine challenge with flying colors.  That particular cough went away after about 10 months. The whole time I was using Flovent, Seravent, & other inhalersl. The cough was not THIS bad, however.

For the last 8 years, I only cough when inhaling cold air, ingesting cold food & beverages or laughing too hard.

The current cough started 12 weeks ago after a couple of days of feeling like I was about to get a cold, but the cold never materialized. I had two days of hoarseness, then the cough started.  Shortly after, I had a sensation of something in my throat & a little mucous there, as well.  My allergy/asthma doctor put me on inhalers.  After 3 weeks of no improvement, he sent me to an ENT.

The ENT scoped my throat, saw my red larnyx and diagosed LPR.  After no luck on Prevacid, I started Nexium, which I've been on for 6.5 weeks (along w/Allegra-D, Flovent, Rhinocort, & Carafate).  The throat lump and mucous went away, but not the cough.

I had an Upper GI last week & it showed nothing. I have no food allergies. I do not have GERD symptoms. My sinus/lung x-rays are clear. Lung function  is excellent. No post-nasal drip.

I've tried a low-carb diet as well as a low-fat diet; neither helped.  Prescription cough medications do not help. I am getting desperate.  Are there tests for other things that I could possibly rule out?  What could possibly be next?  24-hour pH?  Is it possible at all that this is not LPR?

THANK YOU

[Kevin Pho, MD]

A 24-hr pH study and upper endoscopy can further evaluate GERD as a possible cause for the chronic cough.  

Other possibilities would be post-nasal drip, allergies, or the asthma - however it sounds like these options have been evaluated appropriately.

This leaves the GI cause - and I agree that a 24-hr pH test and/or upper endoscopy are reasonable options at this point.

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.

Kevin, M.D.
kevinmd_

[kimberlyrkb]

I forgot to mention I am on 40mg Nexium twice daily, which is supposed to be the effective dosage for LPR.

[jenniwrenne]

I was taking Nexium for over a year and during that time I developed a chronic cough and wheezing, which gradually got worse, and I felt I had a lump in my throat.

Eventually it occurred to me it might be the Nexium which was responsible, so I stopped taking it. I felt an immediate improvement, and 4 weeks later my chronic cough had gone, the wheezing had gone and also the lump in my throat. My doctor said he has known a few people allergic to Nexium (& other PPIs).

I find am better off using H2 Receptor Antagonists to treat excess acid, as and when needed.

I do still cough on occasions if I drink cold water, or am in a hot room.  

A chronic cough can be a symptom of asthma. Or of food intolerances - dairy products and/or gluten are often the main culprits.

Also, have you been investigated for Mast Cell Activation Disorder - that sometimes causes a chronic cough.

[bbally]

Was on Nexium for the same cough for two years.  Finally got switched to protonics and it and the diffuculty swallowing went away for over one year now.  I also take an antihistomine daily.

[golfcart56]

Like you, I have suffered with a non-productive, constant cough for 10 months and have done all of things you mentioned to test plus alot more relating to airway dsyfunctions.  You might want to look into some new technology test that is just now available to establish whether or not your cough is acid based. Go to the website Aeriflux.com for details.  Supposedly it has a very high reliability factor, is not that costly and results are available in days, not months.  I have just completed the testing and await results which will be sent to my gastroenterologist.  Good Luck

[musicchick581]

Go to the Gastroenterologist and have them do a test on you to check your hydrochloric acid content in  your stomach. Nexium will reduce the amount of acid. Doctors a now finding that GERD is related to not enough acid in your stomach, therefore the Nexium will make it worse for you. There are a number of tests that can check the content of hcl in your stomach. Just ask the doctor.