nighttime coughing fits with choking

[Nickkig]

Help!  4 weeks ago I went to the doctor and was diagnosed with bronchitis.  I was treated with Avelox and since then, things have really gone downhill.  Every night I wake up at least twice with severe coughing fits.  When I try to take a breath, no air goes in and I make horrible rasping sounds.  It feels as if my entire breathing system has shut down.  After a minute or two I start breathing normally again, but the anxiety from this has really turned me into a nervous wreck.  In addition, each morning as soon as I sit up in bed I begin to gag, and most mornings I vomit.  During the day I also cough, but the cough is most severe late afternnon into evening.  I do have a lot of mucus, and my doctor recently started me on Advair, which so far, has not helped.  The back of my throat always feels very dry, no matter how much water I drink, and often taking a deep breath or yawning will start a coughing fit.  My biggest concern is the my nightly coughing fits when I can't breathe.  It makes me nervous to go to sleep at night.  I am getting quite desperate as I have not improved at all in 3 weeks.  Please help.

[National Jewish]

Viral infections like bronchitis can cause inflammation of the airways of the lungs.  When this occurs you may cough, especially when you take a deep breath or yawn.  If a virus were the cause the antibiotic you took would not be effective in getting rid of the infection.  If bacteria were the cause a culture of the mucus that you are coughing up would identify the specific bacteria and the most effective antibiotic to get rid of the infection.  However this testing is rarely done since it is much more likely for viruses to cause these infections.

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 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 like Advair™ Diskus® (fluticasone/salmeterol), which is given to treat asthma.  Usually this medicine does not help immediately.  It may need to be used every day for several weeks to months for it to help.  Your doctor is the best judge of this.

The mucus could be coming from postnasal drip.  This is drainage from the nose and sinuses dripping down the back of the throat.  Postnasal drip can cause cough 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.  This would explain the way you feel in the morning.  Talk with your doctor to know if this is a problem for you.

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 you are not on a fluid restriction you should be drinking 6 to 8 8-ounce glasses of non-caffeine non-alcoholic fluid daily.

An antihistamine 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 doctor to see which would help you 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 your cough.  It is most helpful when done daily before using any nasal spray.  A prescription nasal steroid spray decreases mucus production by decreasing the inflammation of the nose and sinuses.  This may prevent the postnasal drip and coughing.  A nasal steroid spray does not provide immediate relief of symptoms.  It may take several weeks of routine use to become effective.  Sometimes it takes the antihistamine, the decongestant, and the nasal wash followed by the nasal steroid spray ALL used routinely to keep the postnasal drip from bothering you.  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 doctor to see if you would benefit from this daily treatment.

[Ellis7]

It sounds like 'acute bronchitis', which is often caused by a virus, so antibiotics may not work. See:
http://www.nationaljewish.org/medfacts/uri.html
UPPER RESPIRATORY INFECTIONS (COLDS) and ACUTE BRONCHITIS
Excerpt:
"Acute bronchitis is an inflammation and irritation of the bronchial tubes (airways) in the lungs. It is usually caused by an infection or, more rarely, by an exposure to chemicals. Symptoms generally include cough with mucus, chest discomfort, fever and extreme tiredness.
.........
An antibiotic is prescribed if you have a bacterial bronchitis. If you have a viral bronchitis, however, an antibiotic may not be prescribed..........
Bronchodilator medications are given if you experience wheezing or shortness of breath. Corticosteroid medications may be used to decrease inflammation and irritation in your airways.

How long the bronchitis lasts is affected by your general state of health, the virus or bacteria involved and how soon you get treatment. Avoiding smoke and other irritants, good nutrition with plenty of fluids, rest and medication are all important. Sometimes viral bronchitis can cause asthma-like symptoms. This is more common in persons with a history of asthma or allergy. This condition's main symptom is a dry, hacking cough that lasts four to eight weeks or longer after the initial infection is over. The cough may be triggered by cold, dry air, smoke or dust."
-----------------------------

[bronham]

I have had this problem for years (probably about 15 years). The first time I remember this happening to me was when I had a severe infection or virus - I did not see a dr. - I went on vacation in the bahamas and spent the whole time in bed. I had this choking event a couple of times  - I thought I was going to die.
Also years ago,I saw a dr. about shortness of breath in the evening he attributed my problems to postnasal drip and stress. He gave me an antihisimine - this didn't really help. Later my drainage got worse and my nose was always red from blowing it... and every once and a while I would get the coughing fit where the top of my windpipe closes up (it does not seem like my lungs do although my airpassages do feel inflammed sometimes). Years later they tried claritan then flonase or something like it - that did nothing. While living in London I got a pnuemonia (pneumonia) many bouts of sinisitis/lung inflammation and had a lot of antibiotics; thye did an astma test on me but did not "see" it but still suspected a slight asthma problem. I frequently went on antibiotics after that. Nothing worked until one day a dr gave me atrovent spray for my nose - this significantly reduced the amount of mucous in my nasal passages.
Alhtough this has helped keep the number of attacks down I still have these coughing fits. Sometimes at night but most of the time while I'm eating - often vinegar on a salad or something else that tickles my throat. Of course once I start coughing my sinuses fill up with mucous and makes the situation worse. It happens a half a dozen times or so year. Each time I'm always afraid I will not recover my breath - the top of my windpipe just closes and I gasp for breath. It scares me and anyone around me. When I'm in a restaurant people have jumped up to give me the heimlech (sp?) manuever but I wave them off because I feel as though this would make things worse. My dr. gave me combivent for an attack but I don't feel it does much. However, this might be because I can't control my breathing to get it down my throat.
Most of the time my husband is around and can be there to "help" (i.e. get the combivent or call 911), but if he's not around I can not explain to anyone what is going on when I'm having an attack. I just wonder what the emergency people would do if I stopped breathing and I could not tell them what is wrong.
I went on-line today to look at my problem because I just had an attack tonight while I was eating dinner. I wish there was something that I could do about this problem.

[ROBYT]

A related discussion, COUGHING FIT was started.

[medhelpsal]

A related discussion, Codeine Linctus was started.