Debilitating Cough

[donna652]

Quick Facts:  42 year old female, otherwise healthy, normal chest xray, never smoked.

Five years ago when I had my first child I developed bronchitis and an uncontrollable cough.  Before this - no history with asthma.  Now every time i get any cold or any sickness I develop a chronic cough that can last many many months.

Most recently I got a cold 3 months ago.  Of course the cold gave me the debilitating cough and I went to my pulmonologist.  In addition to the normal antibiotic treatment, He's found that the only thing that can get rid of the cough is a very high dose of prednisone (60 mg) for 5 or more days with a taper.  This time the cough wouldn't go away even with a long dose of prednisone.  Including the taper i was on it for one month.  When I came off the prednisone I had severe withdrawal symptoms (headache, muscle spasms, almost fainting, no energy, etc). Dr then put me back on with a very gradual taper (5 more weeks).  I've just come off the prednisone now without incident.  

I'm still plagued with an uncontrollable cough that won't go away.  It's to the point where I can't have any conversations without coughing.  I cough all night and it's becoming affecting every area of my life.  Friends don't want to be around me, my business has severely suffered because I can't meet with anyone and when I'm on the phone half of the conversation is spent coughing.

Medications that I'm on for it:  Advair 250/50 twice a day, singulair (10mg), Xoponex nebulized 3 times a day (1.25mg per dose) along with a variety of vitamins.

In the past the only thing that has worked is the high dose prednisone but after my last scare coming off of it, i'm petrified and don't want to go back on it.  

Any insight would be GREATLY appreciated.    

[David Tinkelman, M.D.]

Asthma is a common cause of cough, but asthma is often attributed inappropriately to symptoms from other causes.  Cough, misdiagnosed as asthma can occur with cystic fibrosis, gastro-esophageal reflux disease (GERD), chronic sinusitis, environmental exposures (allergic or irritant, home or occupational) primary ciliary dyskinesia (a disease of impaired airway clearance), airway abnormalities such as tracheomalacia and Bronchomalacia (collapsible airways), Vocal Cord Dysfunction and habit-cough syndrome.
You state, “Now every time I get any cold or any sickness I develop a chronic cough that can last many months.”  

The onset of your chronic cough during pregnancy was most likely fortuitous but the onset or emergence of asthma during pregnancy is not rare.
Another possibility could be recurrent aspiration, with or without the persistence of a foreign body within one of your airways that could intermittently cause cough and yet not be evident on a standard X-ray.  I assume that you have had a high resolution CT Scan of the lungs, but if not, that should be done.

The association with a cold would appear to be cause and effect and the most likely infection of this type would be chronic rhino-sinusitis.  The lengthy persistence of your cough might be secondary, not to ongoing infection, but to ongoing non-specific inflammation precipitated by either viral or bacterial infection.  That would be consistent with the therapeutic response to prednisone, at least in the past.  Yet what often appears to be cause and effect is not always the case and that is why a careful evaluation, looking for one of the many other causes, including relatively rare causes, of chronic cough is so important.

I assume that your pulmonologist has sought and ruled-out the myriad other causes of cough, including the most common causes including chronic recurrent sinusitis and GERD, but after the passage of so much time, it might be time to reconsider and reevaluate for some of these causes.  Sometimes, also, a “fresh look” at a chronic unresolved condition can be helpful and, for this reason, you and your pulmonologist might want to seek a second opinion at any one of a number of major respiratory centers (and their cough clinics) including, but not limited to National Jewish Health in Denver (my institution), Johns Hopkins in Baltimore, the Cleveland Clinic or Mayo Clinic.
I hope this response will be helpful.

Good luck

[yusuf_nbs]

hi i am 30 yrs old male from india.i am having some problem since more than 1.5 years.i do throat clearing all the time .more throat clearing after eating. as if a small mucus is stucked in my throat,which is not comming out.i was admitted for this in hospital.they have lots of tests including ct scan of chest,mri scan of throat,barium meal,endoscopy,24 hr esophagal ph monitoring,usg,blood tests.all are normal.no GERD.what should i do now?
please help me.

e thing i must tell u.this started at sep.2009.at that time,one day i sprayed baygon spray(for killing bugs and moquitoes) in my room ,and then i had to sleep in that room.since then my problem increased.there was some smell of spray.

i am doing this for 1 and half years.now i cant cough and hawk anymore.pls help. ..

[donna652]

Many thanks for the follow up.  This was very helpful.  I've since been to see a "Cough Center" in Tampa.  The doctor was very encouraged that I hadn't been treated for any nasal conditions or GERD.  

He prescribed Nasonex and Patanase as well as recommended a GERD friendly diet and recommended some OTC GERD medication (Prevacid).  After the appointment I took two squirts of the Nasonex - and miraculously the next morning I felt much better.  I continued with the Nasonex and Patanase over the next few days and now I feel probably 80% better.  The cough has diminished from an all the time debilitating cough to one that is just occasional.  

This was after seeing many doctors - both Pulmonologists and ENTs.  It's amazing that they wouldn't think of this before - and that you caught it based off of a simple post on an internet forum.  

Thanks again for this.

Donna