Bronchial Sensitivity and Care for Persistent Coughing

Q: Bronchial Sensitivity and Care for Persistent Coughing

Hello： The three common causes of chronic cough are asthma, allergic rhinitis with post-nasal drip, and gastroesophageal reflux disease (GERD). <br>It is advisable to consult an otolaryngologist to confirm the presence of allergic rhinitis or sinusitis, and medications can be use

Bronchial sensitivity and maintenance issues?

Hello, Doctor: I have been prone to coughing since childhood, especially during seasonal changes or significant weather fluctuations, which makes me more susceptible to colds.
However, often after other cold symptoms have resolved, my cough persists for a long time without improvement.
I have visited three different clinics, but none of the doctors could definitively explain why my cough wouldn't go away.
Later, when I went to the hospital, one doctor suggested that it might be a bronchial allergy to cold air, while another said it could be due to nasal allergies causing post-nasal drip, and prescribed medication for rhinitis.
Last year, after several ineffective visits to the clinic where my cough even worsened, I went to Hospital A's emergency department late at night.
I was then referred to the pulmonology department, where an X-ray showed signs of influenza and pneumonia (not COVID-19).
I couldn't quite understand the X-ray results (the doctor explained that there was a patch of fog and shadow on one side, but I couldn't comprehend it).
The doctor recommended hospitalization, but it was inconvenient at that time, so I took a week off to rest at home and took a lot of medication, but my condition fluctuated.
By then, my cough had lasted over a month.
I underwent other tests, but nothing abnormal was found.
I then went to Hospital B's pulmonology department, where I had another X-ray, but the doctor said I did not have pneumonia at all; I was just more sensitive, possibly due to nasal and bronchial allergies (the doctor even suggested I should see an ENT specialist instead of a pulmonologist).
After taking the medication prescribed by this doctor, I initially saw little improvement, but gradually I started to feel better, leaving me unsure whether it was the medication working or my body healing on its own.
With the change of seasons approaching again, I am worried that I will have to go through the same cycle of visiting family medicine clinics, ENT specialists, and large hospitals as in previous years.
Therefore, I would like to ask the doctor: Is there a way to determine whether my persistent cough is truly due to bronchial allergies or nasal allergies? If it is indeed an allergy issue, what can I do to improve/treat it? Lastly, I would like to know how to take care of my voice, as my current job relies on "voice." If I experience recurrent coughing and cannot speak properly, it will greatly affect my work! Thank you, Doctor, for your patience in reading this, and I hope to receive a response.
Thank you!

Tu, 20~29 year old female. Ask Date: 2020/10/06

Dr. Zheng Jueyi reply Otolaryngology

Hello: The three common causes of chronic cough are asthma, allergic rhinitis with post-nasal drip, and gastroesophageal reflux disease (GERD).
It is advisable to consult an otolaryngologist to confirm the presence of allergic rhinitis or sinusitis, and medications can be used to manage the symptoms of rhinitis.
If you frequently cough at night or experience wheezing, it may be related to asthma, and you should see a pulmonologist for pulmonary function testing.
The best way to maintain vocal health is to drink plenty of water and get adequate rest, while also reducing the intake of fried and spicy foods, and avoiding shouting.
If work permits, using a microphone can be helpful.
Wishing you safety and health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2020/10/06

More Info

Understanding bronchial sensitivity and persistent coughing can be quite complex, especially when symptoms linger despite treatment. It sounds like you've been through a challenging journey with your respiratory health, and I appreciate your detailed account of your experiences. Let's break down your concerns and explore potential solutions.

Understanding Your Symptoms
From your description, it appears that you may be dealing with a combination of bronchial hyperreactivity and possibly allergic rhinitis. Bronchial hyperreactivity refers to an exaggerated response of the airways to various stimuli, which can include cold air, allergens, or respiratory infections. This condition can lead to persistent coughing, especially when other symptoms of a cold or flu have resolved.

On the other hand, post-nasal drip, which occurs when mucus from the nasal passages drips down the back of the throat, can also trigger coughing. This is often seen in individuals with allergies or sinus issues. The fact that your cough worsens during seasonal changes suggests that environmental factors, such as pollen or temperature fluctuations, may be playing a significant role in your symptoms.

Diagnosis and Evaluation
To determine whether your cough is primarily due to bronchial sensitivity or nasal allergies, a thorough evaluation is essential. Here are some steps you can take:
1. Allergy Testing: Consult with an allergist for skin or blood tests to identify specific allergens that may be triggering your symptoms. This can help pinpoint whether your cough is related to environmental allergies.

2. Pulmonary Function Tests: These tests can assess how well your lungs are functioning and whether there is any obstruction or hyperreactivity in your airways.

3. Nasal Endoscopy: If post-nasal drip is suspected, an ENT specialist may perform a nasal endoscopy to visualize the nasal passages and sinuses for any abnormalities.

4. Trial of Medications: Sometimes, a trial of antihistamines or nasal corticosteroids can help determine if allergies are contributing to your cough. If symptoms improve with these medications, it may indicate an allergic component.

Treatment Options
If it is determined that you have bronchial hyperreactivity or allergies, several treatment options can help manage your symptoms:
1. Avoid Triggers: Identify and avoid known allergens or irritants. This may include staying indoors on high pollen days, using air purifiers, and avoiding exposure to cold air.

2. Medications:
- Antihistamines: These can help reduce allergic symptoms and post-nasal drip.

- Nasal Corticosteroids: These are effective for reducing inflammation in the nasal passages and can help alleviate post-nasal drip.

- Bronchodilators: If bronchial hyperreactivity is confirmed, a bronchodilator (such as albuterol) may be prescribed to help open the airways during episodes of coughing.

3. Lifestyle Modifications: Staying hydrated, using a humidifier, and practicing good vocal hygiene can help maintain throat health, especially since your work relies on your voice.

Vocal Care
Given that your job depends on your voice, it's crucial to take care of your vocal cords. Here are some tips:
- Stay Hydrated: Drink plenty of water to keep your vocal cords lubricated.

- Warm Up Your Voice: Before speaking for extended periods, warm up your voice with gentle humming or vocal exercises.

- Avoid Irritants: Stay away from smoke, strong odors, and other irritants that can exacerbate coughing.

- Rest Your Voice: If you feel a cough coming on, try to rest your voice as much as possible to prevent strain.

Conclusion
Persistent coughing can be frustrating, especially when it interferes with your daily life and work. By working closely with healthcare professionals, including allergists and pulmonologists, you can gain a clearer understanding of your symptoms and develop an effective management plan. Remember, it’s essential to communicate openly with your healthcare providers about your concerns and the impact of your symptoms on your quality of life. With the right approach, you can find relief and maintain your vocal health.

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