Aa
My Father's Intractable Cough
Hello,
My father has been having dry cough, cold and irritation in his throat for about a month. After treatment with antibiotics(his chest x-ray was hazy before antibiotics and clear after) did not help, his physician ordered a CT-Scan of Thorax and Neck on 09/09/2011. The abnormal sections of the CT-Scan are below:
CT-Thorax (09/09/2011):
a)Areas of fibrosis with traction bronchiectasis are noted in the anterior segments of right upper lobe. Under 'REMARKS', the report says, "Minimal areas of fibrosis with traction bronchiectasis are noted in the anterior segments of right upper lobe".
b)Few fibrotic lesions are also seen in the apical segment of right upper lobe.
c)Osteophytes are seen from the dorsal vertebral endplates.Early degenerative changes are noted in the dorsal spine.
My father had a similar month long bout with dry cough and cold in March/April 2009. A CT-Scan of the Thorax was done on 04/11/2009. Below, I am reproducing just the parts of the report that were abnormal:
CT- Thorax(04/11/2009):
a)There are focal areas of consolidation in the the medial segment of the right middle lobe and the anterior segment of the right lower lobe. Multiple centri-acinar nodules are seen in both lungs.These findings are probably suggestive of infectious bronchiolitis. For clinicopathological correlation.
b)Fibrobronchiectatic lesions in the anterior segments of the right upper lobe, are probably sequalae of old infection.
My father will be seeing a pulmonalogist on Monday. In the meantime, I would be grateful for any answers that you can give me to my following questions:
a)Does my father have pulmonary fibrosis and/or interstitial lung disease?
b)Do you see a progression of this condition when the CT-Scan of 09/09/2011 is compared with 04/11/2009?
c)Is this a chronic condition for my father? Is there any hope for alleviation of his symptoms or possibly any cure?
How life-threatening is his condition?
Thank you!
Zent
My father has been having dry cough, cold and irritation in his throat for about a month. After treatment with antibiotics(his chest x-ray was hazy before antibiotics and clear after) did not help, his physician ordered a CT-Scan of Thorax and Neck on 09/09/2011. The abnormal sections of the CT-Scan are below:
CT-Thorax (09/09/2011):
a)Areas of fibrosis with traction bronchiectasis are noted in the anterior segments of right upper lobe. Under 'REMARKS', the report says, "Minimal areas of fibrosis with traction bronchiectasis are noted in the anterior segments of right upper lobe".
b)Few fibrotic lesions are also seen in the apical segment of right upper lobe.
c)Osteophytes are seen from the dorsal vertebral endplates.Early degenerative changes are noted in the dorsal spine.
My father had a similar month long bout with dry cough and cold in March/April 2009. A CT-Scan of the Thorax was done on 04/11/2009. Below, I am reproducing just the parts of the report that were abnormal:
CT- Thorax(04/11/2009):
a)There are focal areas of consolidation in the the medial segment of the right middle lobe and the anterior segment of the right lower lobe. Multiple centri-acinar nodules are seen in both lungs.These findings are probably suggestive of infectious bronchiolitis. For clinicopathological correlation.
b)Fibrobronchiectatic lesions in the anterior segments of the right upper lobe, are probably sequalae of old infection.
My father will be seeing a pulmonalogist on Monday. In the meantime, I would be grateful for any answers that you can give me to my following questions:
a)Does my father have pulmonary fibrosis and/or interstitial lung disease?
b)Do you see a progression of this condition when the CT-Scan of 09/09/2011 is compared with 04/11/2009?
c)Is this a chronic condition for my father? Is there any hope for alleviation of his symptoms or possibly any cure?
How life-threatening is his condition?
Thank you!
Zent
Hello Dr.Tinkelman,
My father is 74 years old.
Thank you!
Zent
Hello Dr.Tinkelman,
Thank you so much for your detailed reply!
My father saw his Pulmonalogist(PT) on 09/12/2011 and I was able to speak with the Pulmonalogist over phone as well. Your description of my father's problem matches precisely with that of my father's PT. The PT has prescribed the following medications for ten days and asked my father to see him on 09/21/2011:
1) Azithromycin tablets
2) Deriphyillin tablets
(http://www.livestrong.com/article/175149-deriphyllin-side-effects/)
3) Acebrophylline Capsules
(http://trialx.com/treatment/acebrophylline-copd-medication-indications-side-effects-dosage-interactions-information/
4) Grilinctus BM (Bronchodilator Mucolitic) Syrup
(http://factoidz.com/grilinctus-bm-tablets-and-syrup/)
5) Levocetirizine Tablets
(http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000405/)
My father tells me that he does not see any difference in his condition since he started taking the medications on 09/13/2011. He has lost about 6.5 lbs in one month. As of today, 09/14/2011, his weight is 119 lbs. He weighed 125.5 lbs before his symptoms began on 08/15/2011. He has been eating a bit more fruits and vegetables than he normally eats and drinking more water.His height is 5 ft 3 inches and his waist size is 36 inches.
He has dry cough, irritation in the throat when he coughs and cold. He has no other symptoms. He is able to perform his daily activities without any issues. Once he feels well, he plans on resuming his daily 30 minute exercise bike session and his one mile morning walk. For now, he walks about half a mile in the evening. He does feel sick and dull. He does not feel any weakness.
If you don't mind, I have three quick follow-ups:
a)Would you have any comments about the PT's prescribed medication?
b) How serious is his weight loss of 6.5 lbs in one month?
b)The PT also mentioned a vaccine (is there a pneumonia vaccine?) that he will administer to my father in about 6 months as a preventitive measure to avoid further infections. Is this an effective measure?
If possible, kindly reply.
Thank you again!
Zent
Thank you so much for your detailed reply!
My father saw his Pulmonalogist(PT) on 09/12/2011 and I was able to speak with the Pulmonalogist over phone as well. Your description of my father's problem matches precisely with that of my father's PT. The PT has prescribed the following medications for ten days and asked my father to see him on 09/21/2011:
1) Azithromycin tablets
2) Deriphyillin tablets
(http://www.livestrong.com/article/175149-deriphyllin-side-effects/)
3) Acebrophylline Capsules
(http://trialx.com/treatment/acebrophylline-copd-medication-indications-side-effects-dosage-interactions-information/
4) Grilinctus BM (Bronchodilator Mucolitic) Syrup
(http://factoidz.com/grilinctus-bm-tablets-and-syrup/)
5) Levocetirizine Tablets
(http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000405/)
My father tells me that he does not see any difference in his condition since he started taking the medications on 09/13/2011. He has lost about 6.5 lbs in one month. As of today, 09/14/2011, his weight is 119 lbs. He weighed 125.5 lbs before his symptoms began on 08/15/2011. He has been eating a bit more fruits and vegetables than he normally eats and drinking more water.His height is 5 ft 3 inches and his waist size is 36 inches.
He has dry cough, irritation in the throat when he coughs and cold. He has no other symptoms. He is able to perform his daily activities without any issues. Once he feels well, he plans on resuming his daily 30 minute exercise bike session and his one mile morning walk. For now, he walks about half a mile in the evening. He does feel sick and dull. He does not feel any weakness.
If you don't mind, I have three quick follow-ups:
a)Would you have any comments about the PT's prescribed medication?
b) How serious is his weight loss of 6.5 lbs in one month?
b)The PT also mentioned a vaccine (is there a pneumonia vaccine?) that he will administer to my father in about 6 months as a preventitive measure to avoid further infections. Is this an effective measure?
If possible, kindly reply.
Thank you again!
Zent
MEDICAL PROFESSIONAL
Answered in your previous post, but repeating here to be sure you receive the answer.
A cough, dry or otherwise, that lasts for only a month or so is almost always the result of an acute lung disorder rather than a sign of any type of chronic lung disease.
Comparing the findings (listed by you, below) of the 09/09/11 CT Scan with the findings of the prior, 04/11/09 Scan suggests not progression of any disease, acute or chronic, but rather shows resolution of a number of the abnormalities, especially resolution of the (acinar) pulmonary nodules. The findings on the recent scan are those of chronic localized findings of the right upper lobe (RUL), with nothing to suggest pulmonary fibrosis or any other type of interstitial lung disease.
The abnormal findings in the RUL, on the April 2009 and the 2011 scans are of a type commonly referred to as chronic residual (from a prior infection or inflammatory process) disease.
The 2009 findings, “Fibrobronchiectatic lesions in the anterior segments of the right upper lobe, are probably sequalae of old infection” “segments of right upper lobe. "Minimal areas with traction bronchiectasis are noted in the segments of right upper lobe" and “b)Few fibrotic lesions are also seen in the apical segment of right upper lobe,”
are consistent with a prior infection, possibly tuberculosis d(TB). Bronchiectasis, be it due to TB or another cause can be responsible for chronic cough and/or recurrent infection but when localized as this bronchiectasis seems to be, is more of a nuisance than a sign of serious disease and not at all suggestive of any diffuse, interstitial disease of the lung.
If your father’s most recent bout of coughing for a month is already starting to resolve or has already resolved, further diagnostic tests may be unwarranted but I suggest that you follow the advice of the lung specialist. Should your father continue to raise sputum/phlegm, however, laboratory examination of that for cytology and infection, especially TB, would be non-invasive and could maybe provide useful information.
All in all, what you have described does not have the characteristics of any serious, progressive lung disease.
A cough, dry or otherwise, that lasts for only a month or so is almost always the result of an acute lung disorder rather than a sign of any type of chronic lung disease.
Comparing the findings (listed by you, below) of the 09/09/11 CT Scan with the findings of the prior, 04/11/09 Scan suggests not progression of any disease, acute or chronic, but rather shows resolution of a number of the abnormalities, especially resolution of the (acinar) pulmonary nodules. The findings on the recent scan are those of chronic localized findings of the right upper lobe (RUL), with nothing to suggest pulmonary fibrosis or any other type of interstitial lung disease.
The abnormal findings in the RUL, on the April 2009 and the 2011 scans are of a type commonly referred to as chronic residual (from a prior infection or inflammatory process) disease.
The 2009 findings, “Fibrobronchiectatic lesions in the anterior segments of the right upper lobe, are probably sequalae of old infection” “segments of right upper lobe. "Minimal areas with traction bronchiectasis are noted in the segments of right upper lobe" and “b)Few fibrotic lesions are also seen in the apical segment of right upper lobe,”
are consistent with a prior infection, possibly tuberculosis d(TB). Bronchiectasis, be it due to TB or another cause can be responsible for chronic cough and/or recurrent infection but when localized as this bronchiectasis seems to be, is more of a nuisance than a sign of serious disease and not at all suggestive of any diffuse, interstitial disease of the lung.
If your father’s most recent bout of coughing for a month is already starting to resolve or has already resolved, further diagnostic tests may be unwarranted but I suggest that you follow the advice of the lung specialist. Should your father continue to raise sputum/phlegm, however, laboratory examination of that for cytology and infection, especially TB, would be non-invasive and could maybe provide useful information.
All in all, what you have described does not have the characteristics of any serious, progressive lung disease.
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