Persistent Throat Clearing and Coughing in Active Individuals

Easily hungry and prone to coughing when fasting?

Hello Doctor, my husband (non-smoker, non-drinker, loves to exercise) has been clearing his throat frequently for about three years.
He underwent surgery for inferior turbinate reduction to alleviate nasal congestion, but the throat clearing persists.
He started working out about ten years ago and continues to eat five to six meals daily, yet his weight has not increased and is actually decreasing rapidly—he can lose up to five kilograms in a month.
He typically has bowel movements more than twice a day (mostly soft or liquid stools, no blood).
Whenever he feels hungry or is on an empty stomach, the throat clearing and coughing increase in frequency.
He has been treated for allergic rhinitis and duodenal ulcers with medication, but these conditions have not improved.
I would like to ask the doctor if there could be other possible underlying conditions.

Ms. Huang, 30~39 year old female. Ask Date: 2017/01/04

Dr. Chen Taicheng reply Family Medicine

● There are many reasons for throat clearing, which may be due to a sensation of something stuck in the throat.
The most common causes include post-nasal drip, gastroesophageal reflux disease (GERD), asthma, or certain medications (such as antihypertensives).
It is also important to consider allergic rhinitis, pet ownership, and potential allergens in the environment or workplace.
Other less common causes may include cardiopulmonary diseases or infections (such as tuberculosis).
In the case of the gentleman mentioned, if throat clearing occurs primarily when fasting, gastroesophageal reflux should be prioritized as a potential issue.

● Weight loss is significant if there is a decrease of 10% of body weight within six months.
However, it is essential to determine whether this is due to intentional fitness efforts, such as choosing a higher protein, lower carbohydrate, or low-calorie diet to maintain body composition.
It is advisable to calculate daily caloric intake, which for an average adult male is approximately 25-35 kcal/kg/day.
If weight loss is not intentional, considering the gentleman's age, the most common causes of weight loss may include gastrointestinal issues, such as gastritis, peptic ulcers, dyspepsia, or malabsorption due to insufficient digestive enzyme secretion from the pancreas.
Other potential causes include endocrine issues (such as hyperthyroidism, hyperglycemia, or hypercalcemia), followed by problems related to the heart, lungs, liver, kidneys, chronic infections, or inflammation, which can also lead to weight loss.

● Emotional factors or stress can also impact weight.

● It is recommended to consult with specialists in family medicine, otolaryngology, gastroenterology, endocrinology, and pulmonology for further evaluation and examination.

Respectfully, Dr.
Chen Tai-Cheng, Family Medicine, Taoyuan Hospital.

Reply Date: 2017/01/04

More Info

Persistent throat clearing and coughing can be quite bothersome, especially for active individuals like your husband. Given the symptoms you've described, it’s essential to consider a multifactorial approach to understand the underlying causes.

Firstly, the history of nasal obstruction and the previous surgery to address this issue suggest that there may still be residual effects from nasal congestion or post-nasal drip. Post-nasal drip occurs when excess mucus accumulates in the back of the throat, leading to irritation and a persistent urge to clear the throat. This can be exacerbated by allergies, which you mentioned he has, and can lead to chronic throat irritation and coughing.

Additionally, the symptoms of frequent throat clearing and coughing that increase when he feels hungry or on an empty stomach could indicate a possible connection to gastroesophageal reflux disease (GERD). In GERD, stomach acid can flow back into the esophagus, causing irritation and leading to symptoms such as throat clearing, coughing, and even a sensation of a lump in the throat. This is particularly relevant if he experiences these symptoms more acutely when he hasn't eaten for a while.

The rapid weight loss and frequent soft or liquid stools are concerning and warrant further investigation. Weight loss, especially when unintentional, can be a sign of underlying gastrointestinal issues, such as malabsorption syndromes, inflammatory bowel disease (IBD), or even infections. Given that he experiences frequent bowel movements, it may be beneficial to evaluate for conditions like irritable bowel syndrome (IBS) or other gastrointestinal disorders that could be contributing to his symptoms.

Considering his active lifestyle and the significant changes in his weight and bowel habits, it would be prudent for him to undergo a comprehensive evaluation. This could include:
1. Gastroenterology Consultation: A gastroenterologist can perform tests such as an upper endoscopy to evaluate for GERD, ulcers, or other gastrointestinal conditions. They may also consider stool tests to check for infections or malabsorption.

2. Allergy Testing: Since he has a history of nasal allergies, further evaluation by an allergist may help identify specific triggers that could be contributing to his throat irritation and coughing.

3. Pulmonary Function Tests: If there are concerns about respiratory issues, such as asthma or chronic bronchitis, pulmonary function tests could help assess lung function and airway responsiveness.

4. Dietary Review: A registered dietitian can help assess his dietary intake and ensure he is receiving adequate nutrition, especially given his rapid weight loss.

5. Throat Examination: An ENT specialist can evaluate his throat for any signs of chronic irritation, inflammation, or other abnormalities that may be contributing to his symptoms.

In summary, while the symptoms of throat clearing and coughing can often be attributed to allergies or post-nasal drip, the combination of rapid weight loss and changes in bowel habits necessitates a thorough investigation to rule out any serious underlying conditions. It’s essential to address these symptoms holistically, considering both respiratory and gastrointestinal factors, to provide your husband with the best possible care and relief.

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