Chronic Cough: Symptoms and Seeking Effective Treatment

Q: Chronic Cough: Symptoms and Seeking Effective Treatment

Hello： I understand your current concerns, and here is a brief response： <br>1. <br>Please consider having another chest X-ray. <br>If the physician agrees, arrange for pulmonary function tests to clarify the causes of any lung parenchymal disease and ventilation impairment. <br>

Chronic cough, persistent cough not resolving 2 (ID #130047)

Hello Dr.
Yang,
I've been very busy with school lately, and my persistent cough has severely affected my daily routine and academic performance.
It took me a while to find time to read your response.
My chest X-ray in previous years was normal, but I haven't had one this time.
Is there a possibility that I might have a lung infection or similar issues? Regarding the lung function tests you mentioned, I'm not sure what they entail and whether I've undergone them before, as I've had numerous tests at the hospital over the years.
However, I've experienced significant shortness of breath and nausea during intense exercise since childhood, often feeling breathless and having difficulty breathing, along with chest tightness and dizziness, especially while running.
In recent years, my shortness of breath seems to have worsened; now I get breathless even when climbing stairs or walking briskly, and recently, I've even felt breathless while eating.
Could this be asthma, or is it normal? If it is indeed bronchial sensitivity to cold air, is there a way to cure it? (Aside from traditional Chinese medicine, could dietary therapy be an option?) This situation is incredibly distressing and painful for me! I've been coughing for over a week, taken numerous over-the-counter medications, and consulted two general practitioners without any improvement; it seems to have gotten worse instead.
The first doctor suggested my cough was caused by a cold virus and that it would resolve with over-the-counter medication, advising me to continue taking it.
I tried cough syrup from the pharmacy and cold medicine labeled for expectoration (I currently feel like there's something stuck in my throat, with a lot of phlegm that I can't cough up or swallow, and a persistent uncomfortable sensation in my throat).
None of the over-the-counter medications (including Acetaminophen, Dextromethorphan Polistirex, Dextromethorphan HBr, and Guaifenesin) seemed effective, and rinsing with warm salt water provided no relief.
I then scheduled an appointment at another clinic and saw a doctor yesterday.
He told me that the medication he prescribed should take effect within five days and significantly relieve my cough.
He examined my throat, ears, and nose, and listened to my heartbeat, but I didn't understand many of the medical terms he used, so I'm unsure how he diagnosed me.
I plan to follow his advice.
The doctor prescribed two medications: Prednisone 20MG (14 tablets), to be taken twice daily, one tablet after meals 30-45 minutes later, with the last dose before 5 PM.
From what I read, this medication seems to be for asthma and allergies, and it appears to be a type of steroid.
I'm not sure if the doctor thinks I have bronchial allergies, which is why he prescribed it.
The other medication is Azithromycin 500MG, to be taken once daily for five days (this medication is quite expensive).
The prescription states it is for bacterial infections, and I found out it is a type of antibiotic.
I've taken antibiotics many times in the past without resolving my cough, and I'm concerned that I may have developed antibiotic resistance.
I expressed my reluctance to take antibiotics, but the doctor still prescribed it.
I followed the doctor's prescriptions yesterday, but there hasn't been any noticeable improvement; in fact, my condition seems to have worsened.
Initially, while taking over-the-counter medications, I had a nighttime cough syrup that helped me sleep, but after starting the prescribed medications, I experienced severe coughing last night, gasping for breath, with chest tightness and pain.
I coughed so hard that my throat became painful, and it felt like my lungs were in agony.
I was unable to sleep, and my coughing disturbed my family.
This morning, I continued to cough non-stop, even while eating or drinking warm water, and I started experiencing tinnitus, night sweats, muscle aches, and overall weakness.
Since today is only the second day of taking the prescribed medications, I'm unsure of their effectiveness, but I feel like my condition has worsened.
With school being so busy, I have many responsibilities and can't rest properly or take a leave of absence.
My thoughts are constantly interrupted by coughing, which is incredibly frustrating! Coughing in class has also embarrassed me in front of my professor and classmates.
I noticed your suggestion to wear a mask for warmth, and I have some questions about that.
I'm currently using disposable medical masks, but I find it inconvenient to keep replacing them as I go through them quickly.
Do you have any recommendations for other types of masks, such as reusable or washable ones? Additionally, wearing a mask feels a bit stifling, and my cheeks become itchy when they get damp from sweat, though I can tolerate that for now.
Regarding getting enough sleep, I've been quite busy this semester and often have to stay up late.
My commute to school is long, requiring me to wake up early every day.
Although I'm tired, I try to get as much sleep as I can.
If I can't maintain sufficient sleep, will it worsen my cough? (I'm quite worried about this.)
Lastly, I've tried many cough medications without significant improvement.
The pressure from various aspects of my life is overwhelming, and my physical discomfort is compounded by my emotional distress.
I feel very frustrated; during my severe coughing fits yesterday, I wished I could just pass out and not wake up again.
I suspect I might also need to see a psychologist for counseling, as I'm feeling very low, negative, and pessimistic, and I desperately want relief.
Since I can't fly back to Taiwan for medical care, should I consider seeing a pulmonologist for another consultation and possibly a chest X-ray? If all other potential conditions are ruled out and it turns out I only have bronchial sensitivity to cold air, does that mean I will have to endure endless coughing every winter while living here? My family cannot relocate to a warmer place for my sake.
Thank you for taking the time to read this lengthy message.
I truly appreciate your patience and hope you can provide me with some advice.
Thank you very much!

P, 20~29 year old female. Ask Date: 2017/11/12

Dr. Yang Wenda reply Pulmonology

Hello: I understand your current concerns, and here is a brief response:
1.
Please consider having another chest X-ray.
If the physician agrees, arrange for pulmonary function tests to clarify the causes of any lung parenchymal disease and ventilation impairment.

2.
A regular surgical mask or a cloth mask of your choice is sufficient.

3.
For dietary therapy, consult a traditional Chinese medicine practitioner again to assess your constitution, and then seek their recommendations or do some research on your own.

4.
Adequate rest can improve immune function and alleviate existing symptoms.
Is it possible to extend the deadline for submitting your paper? This would provide you with more time to gather information and also allow for some much-needed rest.

5.
Cold weather is an external factor that cannot be changed, so it is important to add layers such as hats, gloves, masks, scarves, and drink warm water to reduce inhalation or exposure to cold air.
I believe you will gradually see improvement!

Reply Date: 2017/11/12

More Info

Chronic cough can be a frustrating and debilitating condition, especially when it significantly impacts your daily life, sleep, and academic performance. Based on your detailed description, it seems you are experiencing a persistent cough that has not improved despite trying various over-the-counter medications and seeing multiple doctors. This situation can indeed be distressing, and it’s important to approach it systematically.

First, let's address the potential causes of your chronic cough. Given your history of asthma-like symptoms during physical exertion, it is possible that you may have exercise-induced bronchoconstriction or asthma. Asthma is characterized by airway inflammation and hyperreactivity, leading to symptoms such as wheezing, coughing, and difficulty breathing, particularly during or after exercise. The fact that you experience significant shortness of breath and a feeling of tightness in your chest during physical activity further supports this possibility.

Additionally, your cough could be related to post-nasal drip, which often occurs with allergies or sinus issues. This condition can cause mucus to drip down the back of your throat, leading to irritation and a persistent cough. The presence of thick, sticky phlegm and the sensation of something stuck in your throat could be indicative of this.

Regarding the medications prescribed by your doctor, Prednisone is a corticosteroid that can help reduce inflammation in the airways, which may be beneficial if your cough is due to asthma or another inflammatory condition. Azithromycin, an antibiotic, is typically used to treat bacterial infections. If your cough is viral in origin, antibiotics would not be effective, and overuse of antibiotics can lead to resistance, which is a valid concern you raised.

Given that your symptoms have not improved and may even be worsening, it would be advisable to follow up with a pulmonologist (lung specialist). They can perform a thorough evaluation, which may include lung function tests (spirometry) to assess your breathing capacity and determine if asthma or another respiratory condition is present. A chest X-ray can also help rule out any underlying infections or structural issues in the lungs.

In terms of managing your symptoms in the meantime, consider the following strategies:
1. Avoid Triggers: If you suspect cold air exacerbates your symptoms, try to limit exposure to cold environments. Wearing a scarf or mask over your mouth and nose when outside in cold weather can help warm the air before it enters your lungs.

2. Stay Hydrated: Drinking plenty of fluids can help thin mucus, making it easier to expel. Warm teas or broths can be soothing.

3. Humidify Your Environment: Using a humidifier in your room can help keep the air moist, which may alleviate coughing, especially at night.

4. Sleep Position: Elevating your head while sleeping can help reduce coughing at night. Consider using extra pillows or a wedge pillow.

5. Stress Management: Given the emotional toll this situation has taken on you, it may be beneficial to explore stress-reduction techniques such as mindfulness, meditation, or even speaking with a mental health professional.

6. Mask Usage: If you find disposable masks inconvenient, consider using a reusable cloth mask that can be washed. Ensure it has multiple layers for better filtration.

Lastly, regarding your concern about whether you will have to deal with this cough every winter, it is essential to identify the underlying cause. If it is indeed related to asthma or allergies, there are management strategies and treatments available that can help control your symptoms and improve your quality of life.

In summary, I recommend seeking a consultation with a pulmonologist for further evaluation and management of your chronic cough. They can provide a more targeted approach based on your specific symptoms and medical history. Remember, you are not alone in this, and there are effective treatments available to help you find relief.

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