Persistent Cough for 5 Weeks: Seeking Answers and Next Steps

Q: Persistent Cough for 5 Weeks: Seeking Answers and Next Steps

Hello： It is recommended that you seek another hospital outside of your current healthcare system for an X-ray and a professional assessment to determine if there are any significant lung diseases. <br>If the X-ray confirms no obvious lung abnormalities and there is no improvemen

Coughing for 5 weeks?

Hello, Doctor! I have been coughing for 5 weeks and have visited multiple clinics.
Initially, I had a cold with severe throat pain, body weakness, hoarseness, and fever.
After these symptoms improved, the cough began and has persisted until now.
I first visited a general clinic three times without improvement, then started going to a major hospital.
Here are the diagnoses from each visit:
1.
The diagnosis led to a prescription for asthma medication and steroids, which did not improve my condition (X-ray and lung function tests were normal, but the doctor mentioned slight bronchial obstruction).
2.
I was prescribed out-of-pocket medication for gastroesophageal reflux disease, pain relievers (pink round tablets), but there was no improvement.
During this visit, I began experiencing right chest pain that occurs with breathing, coughing, and regardless of my body position.
The doctor mentioned that if there was no improvement, I would need to undergo a tuberculosis test next time, although the likelihood was low, and there is no family history of such diseases.
3.
I was given cough suppressants, anti-inflammatory medication, expectorants, pain relievers, cough syrup, and codeine, which I took for about 3-4 days without improvement.
The doctor did not instruct me to return for follow-up.
4.
Two weeks after the last X-ray, the area of right chest pain expanded, and in recent days, I have also experienced back pain.
The day before the visit, I had half a day of palpitations, sweating, and difficulty breathing.
That night, I woke up in the middle of my sleep due to breathing difficulties, but this was the only instance.
My father asked the doctor if I could have another X-ray, but the doctor refused, stating that I had already had one and that health insurance regulations apply.
Throughout the consultation, the doctor did not suggest any possible causes.
My father continuously inquired about other tests or the possibility of a Mycoplasma infection.
The doctor suggested I try antibiotics and see how it goes, but my father expressed concern about taking them without prior testing, fearing side effects like constipation (blood tests were done).
This visit and the previous one were at the same hospital, and the doctor informed me that the previous physician had already prescribed all available cough medications, including codeine, and he was unsure what else he could prescribe.
As of today, I am still coughing (at all times), producing phlegm, and sometimes experiencing dry cough, chest pain, and overall fatigue.
This morning, I had a fever and later felt chills, but I have not measured my temperature to confirm if I have a fever.
Pain relievers have been ineffective.
I would like to ask the doctor for any suggestions or whether I should consider switching to another healthcare system (all four visits were within the same system).
My father is very concerned that this may develop into pneumonia and hopes for further testing.
What do you think could be the possible causes, and do you have any other recommendations? Thank you!

Ms. Fang, 20~29 year old female. Ask Date: 2018/06/27

Dr. Yang Wenda reply Pulmonology

Hello: It is recommended that you seek another hospital outside of your current healthcare system for an X-ray and a professional assessment to determine if there are any significant lung diseases.
If the X-ray confirms no obvious lung abnormalities and there is no improvement in response to medication, it may be advisable to consider Traditional Chinese Medicine for treatment from a holistic perspective.

Reply Date: 2018/06/27

More Info

It sounds like you have been experiencing a persistent cough for five weeks, along with a range of other symptoms including chest pain, fatigue, and occasional fever. Given the complexity and duration of your symptoms, it's understandable that you are seeking further answers and potential next steps.

Firstly, a cough lasting more than three weeks is considered chronic and warrants further investigation. The fact that you have already seen multiple healthcare providers and undergone various treatments without improvement is concerning. Your symptoms, particularly the chest pain and difficulty breathing, suggest that there may be an underlying issue that has not yet been identified.

Based on the information you provided, here are some possible considerations:
1. Infection: While your initial symptoms were consistent with a viral upper respiratory infection, the persistence of your cough and the development of chest pain could indicate a secondary bacterial infection, such as pneumonia or bronchitis. The fact that your doctor mentioned the possibility of a tuberculosis (TB) test suggests that they are considering infectious causes. TB can sometimes present with a chronic cough and chest pain, especially if there is a history of exposure or risk factors.

2. Asthma or Reactive Airway Disease: Your initial treatment with asthma medications indicates that your healthcare provider was considering asthma as a potential cause of your symptoms. If there is any history of wheezing or shortness of breath, this could be a factor. However, if the medications have not provided relief, it may be worth exploring other diagnoses.

3. Gastroesophageal Reflux Disease (GERD): You mentioned being prescribed medication for GERD. Chronic cough can sometimes be a symptom of acid reflux, especially if stomach acid is irritating the throat or lungs. If you have not noticed any improvement with the GERD treatment, it may be worth discussing this further with your doctor.

4. Pulmonary Issues: Given the chest pain and difficulty breathing, it is crucial to rule out any serious pulmonary conditions. Conditions such as pulmonary embolism (a blood clot in the lungs) or pleuritis (inflammation of the lining of the lungs) could present with similar symptoms. If your symptoms worsen or you experience significant shortness of breath, it would be advisable to seek immediate medical attention.

5. Further Testing: Since your symptoms have not improved and are affecting your quality of life, it may be appropriate to seek a second opinion or request additional diagnostic tests. This could include a CT scan of the chest, sputum culture, or even a bronchoscopy if indicated. These tests can provide more detailed information about what might be causing your symptoms.

6. Medication Review: You mentioned being prescribed various medications, including antibiotics and cough suppressants. It’s important to discuss with your healthcare provider the effectiveness of these treatments and any potential side effects. If you are experiencing adverse effects from medications, this should be addressed.

7. Consider a Specialist: If you have not already, consider seeing a pulmonologist (lung specialist) or an ear, nose, and throat (ENT) specialist. They can provide a more focused evaluation of your respiratory symptoms and may have additional insights or treatment options.

In summary, your persistent cough and associated symptoms warrant further investigation. It is essential to communicate openly with your healthcare provider about your concerns and the impact of your symptoms on your daily life. If you feel that your current healthcare team is not addressing your concerns adequately, seeking a second opinion or consulting a specialist may be beneficial. Your health and well-being are paramount, and it’s important to advocate for yourself in the healthcare system.

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