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.

[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’s doctor is the best judge of this.  Asthma is a chronic form of RAD.  So when this continues, it is generally considered to be asthma.

Postnasal drip is drainage from the nose and sinuses dripping down the back of the throat.  There could be several reasons for this drainage.  One reason is an allergy.  A second reason is a non-allergic, non-infectious inflammation in the sinuses that can linger after a cold.  A third reason is chronic sinusitis.  Postnasal drip can cause coughing and wheezing as a result of irritation of the throat and lungs.  You may experience the postnasal drip as a constant feeling of mucus at the back of your throat.  Typically this is worse at night when you lay down to sleep.  Generally this irritation feels the worst when you wake up and gets better as the day goes on.

The fat content in dairy products can thicken mucus.  Generally eating dairy products with less fat content is helpful.  Drinking plenty of water will help to thin the mucus so that it moves more easily.  As long as your partner is not on a fluid restriction he should be drinking 6 to 8 8-ounce glasses of non-caffeine non-alcoholic fluid daily.

An antihistamine, like the Claritin® (loratadine), can dry up the postnasal drip.  However, it may make the mucus thicker and more difficult to move.  A decongestant like Sudafed® (pseudoephedrine) can thin the postnasal drip and decrease the swelling so it drains easier.  A combination antihistamine-decongestant will do both.  Check with your partner’s doctor to see if Claritin-D® (loratadine/pseudoephedrine), a combination antihistamine-decongestant, would help him more.  Often an antihistamine and decongestant are taken only when the postnasal drip gets bad.  It may be more helpful to take the antihistamine and decongestant on a regular basis.

A nasal wash helps remove mucus and germs from your nose and sinuses.  This can temporarily decrease the postnasal drip and lessen coughing and wheezing.  It is most helpful when done daily before using any nasal spray.  When the postnasal drip is thin and watery Atrovent® Nasal Spray (ipratropium bromide) may help to dry this up.  A prescription nasal steroid spray, like Nasonex® (mometasone), decreases mucus production by decreasing the inflammation of the nose and sinuses.  This may prevent the postnasal drip along with the cough and wheezing.  A nasal steroid spray does not provide immediate relief of symptoms.  It may require several weeks of routine use to become effective.  Sometimes it takes the antihistamine, the decongestant, and the nasal wash followed by the Atrovent® Nasal Spray (ipratropium bromide), and the nasal steroid spray ALL used routinely to keep the postnasal drip from bothering your partner.  Please read our Nasal Wash MedFact at http://www.nationaljewish.org/medfacts/nasal.html for more information about this technique.  Share this information with your partner’s doctor to see if he would benefit from this daily treatment.

[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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[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.