extreme coughing

[UUChris]

My partner (58 y.o.) has attacks of coughing that last for literally hours-- very deep unproductive coughs.  He has no trouble breathing except that it is hard to catch a breath between coughs, though he does have a very small amount of wheezing after a while.  He will be perfectly OK, then his head will suddenly fill with fluid, it runs down his throat, and the tickling of his throat by the fluid is what causes the coughing, which goes then nonstop for 2-3 hours.  Recently a nurse sent us to the ER, and we found that a nebulizer treatment, including a steroid and albuterol, didn't help much, but the A/C in the car did.  His doctor has diagnosed RAD, his spirometry showed normal function, and we are waiting to see an allergist.  Meanwhile he is on pseudofed, Afferin, an albuterol inhaler, 24-hour Claritin, Nasonex, and an inhaled steroid.  Every time we see a doctor they add a medication, but insist on not subtracting any.  The attacks are becoming more frequent-- at least every other night now (almost all are in the evening)-- and longer, with coughs deeper and closer together.  It is possible that exposure to a stain for our fence started this, though it might be a coincidence that both happened at the same time.  Does any of this suggest what his problem might be?  Does RAD make sense?  He doesn't seem to have asthma.  Are these meds the right ones and should he be taking so many?  Thank you.

[SSBama]

A related discussion, Chronic Cough was started.

[National Jewish]

Viral infections like a cold can cause inflammation of the airways of the lungs.  This inflammation can cause coughing and wheezing.  After the cold is gone, it is possible for the inflammation to linger.  This inflammation can last for several weeks.  Sometimes this inflammation may linger for 3 to 6 months.  Eventually the inflammation will go away, and then the coughing and wheezing will stop.  This is called reactive airways disease (RAD) and behaves a lot like asthma.  On a simple breathing test, called spirometry, this may not show up.  This inflammation often clears more quickly when it is treated with an inhaled steroid medicine, which is given to treat asthma.  Usually this medicine does not help after just one use.  It may need to be used every day for several weeks to months for it to help.  Your partner

[norjac]

My husband has IPF and coughs very hard for long periods of time.  The allergist is giving him "shots" for allergies (he tested positive to all the usuals, molds, grasses etc.) He says once the shots begin to take hold the cough will improve.  I'm not so sure.  Have been reading about NAC and folks say it helps the cough and is good for the lungs.  Do you have any info on this.  Is it in liquid form to take?  Would appreciate any news on this.  Thank you.

[Ellis7]

Chronic cough can have many possible causes. RAD triggered by fence stain could be one possibility. Post nasal drip from sinuses could cause it; GE reflux another possibility. Note that Afrin can only be used a short while due to rebound congestion.
See prescribing information.

Links on cough:

http://familydoctor.org/flowcharts/516.html
Cough Flow Chart
"Cough
This annoying symptom has many causes. Follow this chart to help identify your problem and find suggestions for self-care. "
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http://www.aafp.org/afp/981200ap/lawler.html
"An Office Approach to the Diagnosis of Chronic Cough
Chronic cough is a common problem in patients who visit family physicians. The three most common causes of chronic cough in those who are referred to pulmonary specialists are postnasal drip, asthma and gastroesophageal reflux. The initial treatment of patients with cough is often empiric and may involve a trial of decongestants, bronchodilators or histamine H2 antagonists, as monotherapy or in combination. If a therapeutic trial is not successful, sequential diagnostic testing including chest radiograph, purified protein derivative test for tuberculosis, computed tomography of the sinuses, methacholine challenge test or barium swallow may be indicated. By using a standard protocol for diagnosis and treatment, 90 percent of patients with chronic cough can be managed successfully in the family physician's office. However, in some cases it may take three to five months to determine a diagnosis and effective treatment. For the minority of patients in whom this diagnostic approach is unsuccessful, consultation with a pulmonary specialist is appropriate. "
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http://www.pulmonologychannel.com/chroniccough/diagnosis.shtml
Chronic Cough Diagnosis
"A physician should evaluate any chronic cough. The initial step in the evaluation is a medical history and physical examination. This is almost always followed by a chest x-ray. Depending on the results of the initial evaluation, further diagnostic tests may be performed. The tests performed depend on the suspected cause of the cough"
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