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Respiratory Disorders (Expert Forum)
chronic cough triggered by colds
Answered by
David Tinkelman, M.D. - Respiratory Disorder
National Jewish Health
CO
This forum is for questions and support regarding lung and respiratory issues such as: Allergies, Asthma, Bronchitis, Colds - Flu, Chronic Cough, COPD, Cystic Fibrosis, Emphysema, Fibrosis, Lung Abscess, Nasal Polyps, Pleurisy, Pneumonia, Sarcoidosis, Sinusitis, Tuberculosis.
chronic cough triggered by colds
by Lilliahall, Nov 01, 2009 05:49PM
For the past 15 years, every time I have a cold, I am left with a cough that lasts for 3-5 months afterward. I've received many different diagnoses over the years, including postnasal drip, reflux, reactive airways, and (the latest) cough-variant asthma. I have been put on nebulizers, inhalers, prednisone, antacids, antihistamines, decongestants, with no effect.
The cough is always triggered by a cold. Long after the cold is gone, a constant choking cough lingers. It is a shallow but convulsive and exhausting cough. (It feels as if my throat closes when I exhale.) I saw an ENT and then, on her recommendation, an allergist and pulmonologist. The allergist said that I had dustmite allergies and constant mild inflammation, exacerbated by post-nasal drip. She prescribed Xyzal, and I bought dustmite covers for everything. The pulmonologist said that it was cough-variant asthma and put me on Singulair and Asmanex. I was also prescribed an albuterol inhaler.
None of the medications had any effect. The cough eventually faded away (as it always eventually does), after a total of 3 months. I stayed on Singulair and Asmanex as directed. (The hope was that they would stop another cold from triggering the cough.) However, a few weeks later, I caught another cold, and the cough came back worse than ever. I am unable to sleep because I'm coughing so much, sometimes to the point of vomiting. The cough interferes greatly with my work and with my ability to care for my daughter.
I have another appt soon with my pulmologist, but I'm starting to lose hope that he'll be able to help me. I was hoping you might be able to suggest other options or treatments that I could raise with him. (Also, I was wondering if the asthma meds make me more susceptible to catching colds - it is rare for me to get more than 1 cold in a year.) Thanks for any suggestions.
The cough is always triggered by a cold. Long after the cold is gone, a constant choking cough lingers. It is a shallow but convulsive and exhausting cough. (It feels as if my throat closes when I exhale.) I saw an ENT and then, on her recommendation, an allergist and pulmonologist. The allergist said that I had dustmite allergies and constant mild inflammation, exacerbated by post-nasal drip. She prescribed Xyzal, and I bought dustmite covers for everything. The pulmonologist said that it was cough-variant asthma and put me on Singulair and Asmanex. I was also prescribed an albuterol inhaler.
None of the medications had any effect. The cough eventually faded away (as it always eventually does), after a total of 3 months. I stayed on Singulair and Asmanex as directed. (The hope was that they would stop another cold from triggering the cough.) However, a few weeks later, I caught another cold, and the cough came back worse than ever. I am unable to sleep because I'm coughing so much, sometimes to the point of vomiting. The cough interferes greatly with my work and with my ability to care for my daughter.
I have another appt soon with my pulmologist, but I'm starting to lose hope that he'll be able to help me. I was hoping you might be able to suggest other options or treatments that I could raise with him. (Also, I was wondering if the asthma meds make me more susceptible to catching colds - it is rare for me to get more than 1 cold in a year.) Thanks for any suggestions.
Doctor's Answer
by David Tinkelman, M.D., Nov 10, 2009 02:04PM
, Nov 10, 2009 02:04PMTo: Lilliahall
The nicely detailed history you have provided does, indeed, suggest the diagnosis of, Cough-variant Asthma but that diagnosis is inconsistent with the total lack of response (I believe that is what you indicate) to Asmanex, Singulair and albuterol. You note that, “it is rare for me to get more than one cold a year”. That is consistent with a seasonal-cause, be it allergy or infection but would not account for the 3-5 month persistence of cough. Nevertheless, it would be wise for you and your doctors should give careful consideration to potential environmental exposure causes, be the exposure outdoors, at work or in your home.
Two other possibilities come to mind: 1) that you suffer from type of immunodeficiency state that precludes your body from mustering a good response to whatever organism is the cause of your “cold” and, 2) that you have an underlying (non-asthmatic) physical disease of the lungs such as, a) the so-called right middle lobe syndrome) or, b) a condition called bronchiectasis, a physical disorder of the bronchial tubes that predisposes one to lung infection and then is associated with very slow clearing of the infection. Bronchiectasis can be diffuse (throughout one or both lungs) or localized and it may be necessary for you to have a CT Scan of the lungs to make this, or similar diagnoses.
As you know, I am sure, there are a great number of causes of chronic and/or recurrent cough, the causes residing in the upper (nose, throat, sinuses) or lower respiratory tract (the lungs) or even in the gastrointestinal system, most commonly with gastro-esophageal reflux disease (GERD), this latter unlikely in your case, given the recurrent, long periods of relief that have characterized your illness.
Finally, many academic medical centers have Cough Clinics and you might wish to inquire about this in your geographic area. The most renowned physician in the area of Cough is Dr. Richard Irwin. You might want to arrange to see him or, at least, contact him for a recommendation of a cough specialist closer to your home.
Good luck
Two other possibilities come to mind: 1) that you suffer from type of immunodeficiency state that precludes your body from mustering a good response to whatever organism is the cause of your “cold” and, 2) that you have an underlying (non-asthmatic) physical disease of the lungs such as, a) the so-called right middle lobe syndrome) or, b) a condition called bronchiectasis, a physical disorder of the bronchial tubes that predisposes one to lung infection and then is associated with very slow clearing of the infection. Bronchiectasis can be diffuse (throughout one or both lungs) or localized and it may be necessary for you to have a CT Scan of the lungs to make this, or similar diagnoses.
As you know, I am sure, there are a great number of causes of chronic and/or recurrent cough, the causes residing in the upper (nose, throat, sinuses) or lower respiratory tract (the lungs) or even in the gastrointestinal system, most commonly with gastro-esophageal reflux disease (GERD), this latter unlikely in your case, given the recurrent, long periods of relief that have characterized your illness.
Finally, many academic medical centers have Cough Clinics and you might wish to inquire about this in your geographic area. The most renowned physician in the area of Cough is Dr. Richard Irwin. You might want to arrange to see him or, at least, contact him for a recommendation of a cough specialist closer to your home.
Good luck
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