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Avatar universal

cough for 3 months

Hi, I've had this cough for 3 months, the first 4 days i couldn't sleep because there was just a never ending amount of mucus in my throat, a tickle, even the cough medicine didn't help because the tickle wouldn't stop. I saw my pulmonary doctor who performed a spirometry and it fev 1 120% of normal with no indications of anything, all the other results were also in the normal range. Chest xray normal. Sinus ct scan normal. He sent me to the ENT who said it was red in the vocal cords/larynx i believe possibly due to acid reflux - he told me to take zantac 150 mg twice a day which I started a week ago and doesnt seem to be helping. The main thing is this cough goes away for a few days then can come back. One key thing is once I fall asleep after coughing, I do not cough while sleeping and if I wake up in the middle of the night to urinate I don't cough. Once I wake up I don't cough until about 30 minutes or until I get out of bed.
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Avatar universal
Doctor, the fact that is goes away for a few days then comes back - what does that possibly rule out? I just went to another ENT and he said he saw no signs of reflux at all, and he examined my vocal cords and throat for about 15 minutes asking me to make certain sounds etc...    I don't know if it's a coincidence but my other roommate is also coughing for the last 3 months with the same symptoms. Nothing wrong with the place however, a few other people live here with nothing.
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242587 tn?1355424110
MEDICAL PROFESSIONAL
There are many causes of cough, but the fact that the “cough goes away for a few days and then comes back” eliminates many of the causes from consideration.  The observation of “redness in the vocal cords” indicates inflammation of the cords; a finding that cannot be ignored and, in fact, may be a clue to the diagnosis, be the cause infection, reflux or allergy.  Considerations of the cause of this redness would include asthma and Gastroesophageal reflux disease (GERD) as has been suspected by your doctors.  While unlikely, it is conceivable that reflux disease, if the cause might occur primarily during your waking hours and not while asleep.  It is also possible that this persistent cough is secondary to the slow resolution of infection with pertussis (whooping cough).

A trial of both reflux and asthma therapy is not unreasonable.  However, an optimum trial for asthma would include an inhaled steroid drug along with albuterol.  And a trial of therapy of GERD would optimally include a drug in a class of drugs called Proton Pump Inhibitors, for example Omeprazole (Prilosec).  In addition, there are additional, non-pharmacologic  steps one can take in the treatment of GERD such as dietary restrictions, smoking cessation and alteration in sleeping position (elevation of the head of the bed).  You should discuss the information in this paragraph with your doctor.  With reference to the reddened vocal cords, a failure to respond to one of the Proton Pump Inhibitors, does not rule out the diagnosis of GERD and if your doctor is still clinically suspicious of this, it may be necessary to perform 24 hour esophageal pH monitoring or even direct examination of the esophagus by a gastrointestinal specialist.

Sleep suppresses cough and the biological mechanisms for this action are poorly understood. Cough has recently been reported as a presenting symptom of a common sleep disorder called, obstructive sleep apnea. Cough frequency is much lower at night than during the day thought to be a result reduced exposure to tussive (cough-producing) stimuli at night and decreased cough reflex sensitivity. The presence or absence of nocturnal cough is not helpful in establishing the etiology.

I all the above and time fail to result in cough cessation, you and your doctor may wish to consider requesting consultation with a Cough Clinic, most of these associated with the nearest university medical center.

Good luck
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Avatar universal
Forget to mention - he mentioned this might be cough variant asthma so we tried albuterol and it doesn't help the cough. Any ideas what I can ask the doctors to check or what it could be? all out of ideas
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