Chronic Cough and Chest Tightness: Your Symptoms

Persistent cough and chest tightness?

Hello, doctor.
After catching a cold in early 2015, I experienced a persistent cough for over two weeks and visited a pulmonologist.
An X-ray showed no abnormalities, and the doctor prescribed a herbal syrup (I remember it was either made from grass jelly or licorice), which helped me recover.
A few months later, I caught another cold, but the cough was not severe.
However, during light activities like brisk walking or climbing stairs, I would become breathless to the point of being unable to speak, with a rapid and forceful heartbeat.
After a cardiac examination, I was referred to an endocrinologist and diagnosed with hyperthyroidism, for which I have been on medication ever since (including antiarrhythmic medication, Entresto).
At the end of that year, I traveled abroad for work and frequently caught colds, each time accompanied by a prolonged cough.
Doctors abroad prescribed antibiotics, bronchodilators, and cough syrups, which made me feel better, but I would catch another cold within two months, repeating this cycle.
Recently, during the last two episodes, I coughed to the point of feeling tightness in my chest and almost unable to breathe, with wheezing likely due to mucus.
The wheezing affects my sleep.
The same bronchodilator is no longer as effective as before; I need to take 3 to 4 doses before I can sleep, otherwise, I can only sleep propped up on my side or even sitting up.
Lying flat immediately causes chest tightness and coughing.
The tightness and discomfort in my chest resolve after taking medication but return with the next cold, while the cough has become a daily occurrence.
It is usually not severe, but I always cough upon waking, with mucus often being clear, solid, granular, or elongated.
Sometimes I experience a dry cough.
I am very sensitive to alcohol; even a sip will trigger a cough, and I cough just from smelling alcohol-containing products.
Laughing also induces coughing.
In May 2016, I had another chest X-ray taken abroad for residency purposes, and the result was clear.

Should I get another X-ray? Or could this be an issue with my immune system? I do not smoke, and the air quality in my living area is good.
Thank you for your response!

YL, 40~49 year old female. Ask Date: 2017/02/16

Dr. Wang Lanfeng reply Pulmonology

Hello, based on your current symptom description, it appears to be an acute asthma attack.
I recommend that you visit a pulmonology clinic for further evaluation.
Thank you.

Reply Date: 2017/02/16

More Info

Chronic cough and chest tightness can be distressing symptoms that significantly impact your quality of life. Based on your history, it appears that your symptoms have persisted for several years, often exacerbated by respiratory infections and possibly linked to underlying conditions such as hyperthyroidism and asthma.
From your description, it seems that you have experienced recurrent respiratory infections, leading to chronic cough and associated symptoms like chest tightness and difficulty breathing. The fact that you have been prescribed bronchodilators and have experienced varying effectiveness suggests that there may be an underlying reactive airway condition, such as asthma. Asthma can be triggered by various factors, including respiratory infections, allergens, cold air, and even exercise.
Your symptoms of coughing, especially upon waking, and the presence of phlegm that is sometimes clear or granular, could indicate ongoing airway inflammation or bronchial hyperreactivity. The fact that you experience tightness in your chest and difficulty breathing when lying flat suggests that you may have some degree of airway obstruction, which can be common in asthma or other chronic respiratory conditions.

Given your history of hyperthyroidism, it is also essential to consider how this condition might interact with your respiratory symptoms. Hyperthyroidism can lead to increased heart rate and palpitations, which may contribute to feelings of chest tightness or discomfort. Additionally, the medications you are taking for hyperthyroidism and heart rhythm issues may have side effects that could influence your respiratory health.

Regarding your question about whether you should have another chest X-ray, it may not be necessary at this time if your previous X-rays have been clear and you are not experiencing any new concerning symptoms, such as significant weight loss, hemoptysis (coughing up blood), or persistent fever. However, if your symptoms worsen or if you develop new symptoms, further imaging or pulmonary function tests may be warranted to assess your lung function and rule out any complications.

It is also crucial to consider your sensitivity to alcohol and other triggers, as these can exacerbate your symptoms. Avoiding known irritants and triggers, including alcohol, strong odors, and allergens, can help manage your symptoms.
In terms of management, it may be beneficial to work with a pulmonologist or an allergist to evaluate your symptoms further. They may recommend a comprehensive asthma evaluation, including spirometry to assess lung function and possibly allergy testing to identify any specific triggers.
In summary, your chronic cough and chest tightness are likely multifactorial, involving a combination of asthma, possible hyperthyroid effects, and recurrent respiratory infections. A thorough evaluation by a specialist can help clarify your diagnosis and guide appropriate treatment strategies to improve your quality of life. In the meantime, continue to monitor your symptoms, avoid known triggers, and maintain open communication with your healthcare provider regarding any changes in your condition.

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