Persistent Cough for Over Three Weeks: When to See a Specialist?

I have been coughing for more than three weeks. Could you please advise, doctor?

Hello Doctor, my girlfriend (20 years old, weighing 60 kg) has been experiencing a cough from October 1 to October 23.
Based on the sound of her cough, it sometimes produces phlegm (but she cannot expectorate it) and sometimes it is dry.
She often wakes up at night due to coughing and even when she falls asleep, she feels restless because of an itchy throat.
When she coughs, she feels a sensation of air being pulled up from the junction of her neck and chest.
We have visited a nearby clinic three times, and while her condition improved during the medication period, it relapsed after finishing the medication.
On October 21 (Friday), I took her to Hsinchu Mackay Memorial Hospital, where an ENT doctor examined her and simply stated, "Take the medication for a week, and come back if there are any issues." We are a bit worried due to the unclear situation and are unsure if it would be better to see a pulmonologist for a chest X-ray.
Currently, the medications prescribed by Mackay are: 1.
BENSAU* SOFT CAP (benzonatate 100 mg) - take four times daily; 2.
Morbica sustained-release tablets (Loratadine/Pseudoephedrine combination) - take twice daily; 3.
MUSCO* TAB (Ambroxol 30 mg) - take four times daily; 4.
ComPESOLON* TAB (prednisolone 5 mg) - take three times daily (this medication seems to be a steroid?); 5.
IweLL* TAB - take three times daily; 6.
MECATER* TAB (Pocaterol HCL 25 mg) - take twice daily; 7.
COUGH mixture* A (take four times daily, this is a liquid medication).
After taking these medications for a day, she still has a slight cough.
We are wondering if the doctor recommends that we see a pulmonologist? Since the ENT doctor did not provide specific information about her condition, we are somewhat concerned.
Thank you for your time, and I wish you good health! (Note: My girlfriend does not have any bad habits like smoking or drinking, studies in Taichung, and tends to stay up late.)

Niming, 20~29 year old female. Ask Date: 2016/10/23

Dr. Zheng Jueyi reply Otolaryngology

Hello, generally if there is no fever, it is less likely to be pneumonia.
It is recommended to complete the medication.
If there is no improvement, you may consider a re-evaluation by a pulmonologist.
Wishing you safety and good health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2016/10/23

More Info

Persistent cough lasting over three weeks can be concerning, especially when it disrupts sleep and is accompanied by symptoms such as throat irritation and difficulty expectorating phlegm. Given your girlfriend's situation, it is essential to consider a few factors and potential next steps.

Firstly, the medications prescribed by the ear, nose, and throat (ENT) specialist indicate that the doctor is addressing both the cough and any underlying inflammation or irritation in the respiratory tract. Benzonatate is a cough suppressant, while the combination of loratadine and pseudoephedrine targets allergy symptoms and nasal congestion. Ambroxol is a mucolytic agent that helps thin mucus, making it easier to expel. Prednisolone, a corticosteroid, is used to reduce inflammation, and the other medications aim to manage symptoms effectively.

However, the fact that your girlfriend's cough persists despite medication suggests that further evaluation may be necessary. Here are some considerations and recommendations:
1. Duration and Nature of Cough: A cough lasting more than three weeks, especially if it is disruptive to sleep and associated with phlegm, warrants further investigation. While acute coughs are often viral and resolve within a few weeks, a persistent cough can indicate other issues, such as post-nasal drip, asthma, bronchitis, or even more serious conditions like pneumonia or interstitial lung disease.

2. Chest X-ray: Given the duration of the cough and the symptoms described, it would be prudent to consult a pulmonologist (chest specialist) and consider a chest X-ray. This imaging can help rule out conditions such as pneumonia, lung masses, or other structural abnormalities in the lungs.
3. Allergy and Asthma Considerations: Since your girlfriend is experiencing nighttime coughs and throat irritation, it may be beneficial to evaluate for allergies or asthma. Allergies can lead to post-nasal drip, which irritates the throat and triggers coughing, especially at night. A pulmonary function test may also be warranted to assess for asthma.

4. Follow-Up with ENT: If the cough does not improve or worsens, it may be necessary to return to the ENT for further evaluation. They may consider additional tests, such as a laryngoscopy, to examine the throat and vocal cords for any abnormalities.

5. Lifestyle Modifications: Encourage your girlfriend to stay hydrated, avoid irritants (such as smoke or strong odors), and consider using a humidifier in her room to alleviate throat dryness. Additionally, sleeping with her head elevated may help reduce nighttime coughing.

6. Monitoring Symptoms: Keep a close eye on any changes in symptoms. If she develops fever, shortness of breath, or if the cough produces blood or changes in color, seek immediate medical attention.

In summary, while the medications prescribed by the ENT are appropriate, the persistence of the cough suggests that further evaluation is necessary. Consulting a pulmonologist for a chest X-ray and possibly additional tests would be a wise next step. It’s essential to address any underlying issues to ensure your girlfriend's health and well-being.

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