Chronic Cough when I laugh

[kkush]

Hi,
I am 27 years old.  8 years ago I got very sick with a still unknown cause.  Some sort of bad ear infection/general auto immune problem.  I have celiac disease (I am allergic to wheat) but at that time it was not diagnosed and I was eating a lot of wheat.  When I got so sick I also developed a horrible cough.  When I would talk or socialize a lot I would cough up a ton of phlegm.  It was all white, but it was a tremendous ammount.  I didn't have any problem breathing, and normally I never felt like I had a cough except when I would be talking a lot.  It took me about 6 months to really start feeling better after this sickness, but the cough has stayed with me.  It has gotten a lot better, but I still cough when I go out and socialize with friends.  It is very strange because it is only when I am talking a lot with friends, not my family - i think I must be a little more tense when I am talking which somehow changes something in my lungs.  I generally don't have trouble breathing and my cough hasn't gotten better.  However recently I got a bad cold, and I noticed that my phlegmy coughs were getting worse again.  If I never socialized I wouldn't know that I even have a cough.  it feels like there is mucus trapped somewhere deep in my lungs that only comes out at a certain time.  I have seen doctors but they have listened to my lungs and said they sound fine.  Any thoughts about what this is and/or how I can get rid of it?  I do have other chronic allergies and food sensitivities.  Also I am planning to have a baby soon, should I be worried about this for pregnancy?

Thanks

[David Tinkelman, M.D.]

Environmental and genetic factors are important in the development of celiac disease. The alcohol-soluble protein fraction of wheat gluten, the gliadins, and similar prolamins in rye and barley trigger intestinal inflammation in susceptible individuals. Oat grains, which have prolamins rich in glutamine but not proline, are rarely toxic. Approximately 15% of first-degree relatives of affected individuals are found to have celiac disease. Predisposition to gluten sensitivity has been mapped to the HLA-D region on chromosome 6.

Pulmonary disease is not a direct manifestation of Celiac Disease, but there is one lung disease that has been found to be associated with Celiac Disease and that disease is an otherwise very uncommon one, Idiopathic Pulmonary Hemosiderosis.  There are case reports of the lung condition resolving, along with the Celiac Disease, with the implementation of a gluten-free diet, suggesting that the two diseases may share a common mechanism. See the following abstract.  If that is the case, subsidence of the pulmonary component may require even more stringent dietary restrictions than those that suffice to eradicate the Celiac Disease.

[Authors Full NameKhemiri, M. Ouederni, M. Khaldi, F. Barsaoui, S.
InstitutionDepartment of Pediatric Medicine A, Children's Hospital of Tunis, Bab-Saadoun-Jabbary, Tunis, Tunisia. monia.***@****
TitleScreening for celiac disease in idiopathic pulmonary hemosiderosis.
SourceGastroenterologie Clinique et Biologique. 32(8-9):745-8, 2008 Aug-Sep.
AbstractAIM: The aim of this report was to screen for celiac disease (CD) in patients with idiopathic pulmonary hemosiderosis (IPH). PATIENTS AND METHODS: Patients with IPH treated at the Children's Hospital of Tunis between 1976 and 2006 were reviewed and investigated for CD, using serological and histological tests. RESULTS: A total of 10 children (two boys and eight girls) had IPH. The mean age at diagnosis was 3.1 years. Three had digestive symptoms and positive CD serology, which was confirmed by histological data. Clinical and radiological findings improved markedly in all CD patients with corticosteroid treatment combined with a gluten-free diet. Symptoms of IPH and CD both returned in one patient who stopped the gluten-free diet. CONCLUSION: Three of our 10 patients with IPH also had CD. These data illustrate the close etiopathogenic link between IPH and CD, and strongly suggest that CD be looked for in IPH patients, especially in those with symptoms suggestive of CD.]

The current circumstances of your cough (in social situations) suggest that the cough, at least in part, may be on the basis of emotional factors and/or be what is called an habitual or psychogenic cough (a residual of what was initially a physical-disease based cough.  On the other hand,  the recurrence of a “phlegmy cough” suggests that the cause of your original, very productive cough, whatever that cause, may not have completely resolved but, rather, become dormant, the recurrence precipitated by infection.

The description you have provided suggests that you have not have a complete evaluation of your cough and the pulmonary disease reflected by it.  I strongly suggest that you seek consultation with a lung specialist (pulmonologist) and, given the unusual features of your cough, that you see a pulmonologist at a University (Medical School Associated) Academic Medical Center or at an institution dedicated to the diagnosis and treatment of respiratory disease such as National Jewish Health in Denver or Johns Hopkins in Baltimore, MD.  I believe it to be most important to establish a diagnosis with reasonable certainty, at your young age, in the interest of preventing re-emergence of lung disease later on in life.

I also strongly suggest that you initiate efforts to get to the bottom of this, prior to becoming pregnant.

Good luck

[kkush]

and i've never smoked.

[kkush]

I forgot to mention - I don't have asthma, but my father has asthma and COPD.