Persistent Cough and Itchy Airways: Seeking Answers for Unresolved Symptoms

Chronic bronchial itching and cough that cannot be resolved?

Hello, doctor.
I had a cold at the beginning of April, and after recovering, I started experiencing intense itching from my throat to my chest (likely in the trachea).
Pressing firmly on my chest or the area between my throat and chest makes the itching sensation more pronounced and triggers coughing.
I have visited three clinics and two large hospitals.
In both hospitals, I underwent X-rays, and the doctors said there were no issues.
However, the doctors suspected a mycoplasma infection based on the X-ray results, so they arranged for a blood test, which showed a level of 40.
Despite taking medication for mycoplasma, there was no improvement.
Later, I suspected gastroesophageal reflux disease (GERD) and underwent an endoscopy.
The doctor who performed the endoscopy told me he did not find anything unusual or concerning.
He asked why I was there, and I informed him about my persistent cough.
He mentioned that the endoscopy could only reveal one-third of the reflux phenomenon (which I didn't quite understand).
I also had an allergy test, which showed high levels (4) for dust mites, dust, and cat dander.
Consequently, the doctor started treating me for "allergic effects on the trachea," prescribing allergy medication and a nebulizer.
However, after nearly a week of taking the allergy medication, I have not noticed any improvement, and I have also organized my bedding at home.
It has been over two months since I developed bronchial itching and coughing after the cold.
More than a week after the cold, I had noticeable nasal discharge, which was thick, transparent, and colorless, lasting about a week.
After that, my persistent cough was completely dry, with no mucus, only occasional thick, clear, colorless bubbles resembling saliva.

I would like to ask the doctor: 1.
I am concerned about lung issues due to my prolonged cough and have inquired whether a CT scan is necessary.
Three doctors have told me that as long as the X-ray is normal, a CT scan is not necessary unless the X-ray shows abnormalities.
Is this correct? 2.
I have already undergone allergy testing, an endoscopy, and taken mycoplasma medication, as well as medication for post-nasal drip, but I have not seen any effects.
Are there other possibilities? Or are there indeed cases of bronchial itching and coughing lasting this long? Thank you, doctor, for your answers.
I am very worried about not being able to find a solution and whether I might have a serious illness.

Dino, 20~29 year old female. Ask Date: 2016/06/15

Dr. Hong Yuanbin reply Internal Medicine

Based on the medical condition, it is important to clarify whether everything was normal before the cold in April, whether there are any underlying diseases, and if there are any other illnesses in the family to determine the relationship with the cold in April.
Therefore:
Situation A: If everything was normal before the cold in April, with no diseases or discomfort, we can infer that the chronic cough is likely related to the cold in April.
Clinically, we do encounter cases where a cold leads to pneumonia or chronic bronchitis resulting in a prolonged cough.
If the chest X-ray is normal, then the likelihood of chronic bronchitis is high.
We can attempt to use strong antitussive medications to alleviate the cough; in some cases, after treatment, chronic bronchitis may improve, allowing us to discontinue the cough medication.
Situation B: If there were pre-existing issues before the cold, these may include:
1.
Allergic rhinitis, which could lead to post-nasal drip; antihistamines combined with moderate exercise may help improve this condition.
2.
Heartburn after meals, which may indicate gastroesophageal reflux disease (GERD).
While an endoscopy may not provide a definitive diagnosis, one can try eating smaller, more frequent meals, avoiding lying down within an hour after eating, and steering clear of irritants like tea, coffee, and alcohol to see if symptoms improve.
3.
If there has been a history of chronic cough, we would be concerned about tuberculosis; however, if the chest X-ray is normal, the likelihood is low.
If there are still concerns, sputum tests can be considered.
4.
Some individuals may experience coughing while lying down, which could be due to pulmonary edema, often associated with heart failure or liver/kidney dysfunction.
If there is a chronic cough and the chest X-ray shows no significant findings, further investigation in these areas may be warranted.
5.
The above are the most common causes, but rare causes may also be responsible, necessitating detailed examinations.
As for the X-ray, if it is completely normal, a CT scan may not be necessary, as it is rare for a normal X-ray to miss issues that a CT scan would reveal.
Chronic cough is a common clinical problem, and we often encounter many patients requiring prolonged evaluation and treatment.
However, with accurate diagnosis and treatment, most cases will improve.
Thank you for your inquiry, and I wish you a speedy recovery.

Reply Date: 2016/06/15

More Info

Persistent cough and itchy airways can be quite distressing, especially when they linger for an extended period. Based on your description, it seems you have undergone a thorough evaluation, including X-rays, allergy testing, and even an endoscopy, which have not provided conclusive answers or relief. Let's address your concerns systematically.

1. Is it correct that a CT scan is unnecessary if X-rays show no issues?
Yes, generally speaking, if a chest X-ray does not reveal any abnormalities, many healthcare providers may consider a CT scan unnecessary. X-rays are typically the first-line imaging modality for evaluating lung conditions, and they can identify significant issues such as pneumonia, tumors, or large pleural effusions. However, CT scans provide more detailed images and can detect smaller lesions or conditions that X-rays might miss. If your symptoms persist and you continue to have concerns about your lung health, it would be reasonable to discuss the possibility of a CT scan with your healthcare provider, especially if your cough is accompanied by other concerning symptoms such as weight loss, night sweats, or hemoptysis (coughing up blood).

2. What other possibilities could explain your persistent cough and itchy airways?
Given that you have already ruled out several common causes, here are a few additional considerations:
- Postnasal Drip: Even if you are not experiencing significant nasal congestion, postnasal drip can occur with allergies or sinus issues, leading to throat irritation and a persistent cough. This can sometimes be treated with antihistamines or nasal corticosteroids.

- Gastroesophageal Reflux Disease (GERD): You mentioned having a suspicion of GERD, and while your endoscopy did not reveal significant issues, GERD can still cause chronic cough due to acid irritating the esophagus and throat. You might consider discussing a trial of proton pump inhibitors (PPIs) with your doctor if you haven't already.

- Asthma or Reactive Airway Disease: Your symptoms of itchy airways and cough could indicate asthma, especially if they are triggered by allergens or irritants. A pulmonary function test (spirometry) can help assess for asthma or other obstructive airway diseases.

- Chronic Bronchitis or Other Chronic Respiratory Conditions: If you have a history of smoking or exposure to irritants, chronic bronchitis could be a possibility. This condition is characterized by a persistent cough and mucus production.
- Allergic Rhinitis or Environmental Allergies: Since your allergy tests showed sensitivity to dust mites, pet dander, and other allergens, it’s possible that ongoing exposure to these allergens is contributing to your symptoms. Implementing strict environmental controls, such as using air purifiers, hypoallergenic bedding, and regular cleaning, may help.

- Psychogenic Cough: In some cases, chronic cough can be related to stress or anxiety. If other medical explanations have been ruled out, this could be a consideration.

3. Is it common to have a persistent cough for this long?
Yes, there are cases where individuals experience prolonged coughs due to various underlying conditions. Chronic cough is defined as a cough lasting more than eight weeks, and it can stem from a multitude of causes, including those mentioned above.
In conclusion, while it is understandable to be concerned about your health, it is essential to continue working with your healthcare providers to explore these possibilities. If your symptoms persist without improvement, consider seeking a second opinion or consulting a specialist, such as an allergist or pulmonologist, who may offer additional insights or treatment options. Remember to keep a detailed record of your symptoms, triggers, and any treatments you have tried, as this information can be invaluable in guiding your care.

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