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 to manage the symptoms

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 the emergency department at Hospital A late at night.
I was then referred to the pulmonology department, where an X-ray revealed influenza and pneumonia (not COVID-19).
I didn't quite understand the X-ray results (the doctor explained that there was a patch of haziness and shadows on one side, but I couldn't comprehend it).
The doctor recommended hospitalization, but it was inconvenient at the time.
I took a week off to rest at home, took a lot of medication, but my condition fluctuated.
By then, my cough had lasted over a month, and additional tests showed no abnormalities.
I then went to Hospital B's pulmonology department, where another X-ray was taken.
The doctor stated that I did not have pneumonia at all, but was rather 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 began to feel better, leaving me unsure whether it was the medication working or my body healing on its own.
As the seasons are changing again, I am worried about having to run between family medicine clinics, ENT specialists, and large hospitals like 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, how can I improve or treat it? Lastly, I would like to know how to take care of my voice, as my current job relies on "voice." Recurrent coughing and difficulty speaking would greatly disrupt my work! Thank you for your patience in reading this, and I hope to receive a response.
Thank you!

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

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 to manage the symptoms of rhinitis with medication.
If you frequently cough at night or experience wheezing, it may be related to asthma, and a pulmonary function test can be performed in a pulmonology clinic for confirmation.
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: 2020/10/10

More Info

Persistent coughing can be a frustrating and debilitating issue, especially when it interferes with daily activities and quality of life. Based on your description, it seems that you have been dealing with this problem for quite some time, and it may be related to bronchial sensitivity or allergies. Let's break down the potential causes and management strategies for your situation.

Understanding the Causes
1. Bronchial Sensitivity: It is common for individuals to experience heightened sensitivity in their airways, particularly in response to environmental changes, such as temperature fluctuations or exposure to allergens. This sensitivity can lead to bronchospasm, resulting in coughing, wheezing, and difficulty breathing.

2. Post-Nasal Drip: Allergies or sinus issues can cause mucus to drip down the back of the throat, triggering a cough reflex. This is often exacerbated by lying down, which can worsen nighttime coughing.

3. Infections: While you have mentioned that previous infections were ruled out, it is important to consider that viral infections can linger, causing prolonged coughing even after other symptoms have resolved.

4. Allergic Rhinitis: If you have a history of allergies, it is possible that your nasal passages are inflamed, leading to post-nasal drip and subsequent coughing.

5. Asthma: Given your history of coughing, especially in response to cold air or seasonal changes, asthma could be a contributing factor. Asthma is characterized by airway inflammation and hyperreactivity, leading to symptoms such as coughing, wheezing, and shortness of breath.

Diagnostic Approaches
To determine whether your coughing is due to bronchial sensitivity, nasal allergies, or another underlying condition, consider the following steps:
1. Allergy Testing: Consult with an allergist for skin or blood tests to identify specific allergens that may be triggering your symptoms.

2. Pulmonary Function Tests: These tests can help assess your lung function and determine if asthma or another respiratory condition is present.

3. Nasal Endoscopy: If post-nasal drip is suspected, an ENT specialist may perform a nasal endoscopy to evaluate the nasal passages and sinuses for inflammation or other issues.

4. Trial of Medications: Sometimes, a trial of antihistamines, nasal corticosteroids, or bronchodilators can help clarify the diagnosis based on symptom improvement.

Management Strategies
1. Avoid Triggers: Identify and avoid known allergens or irritants, such as dust, pollen, smoke, and strong odors. Keeping windows closed during high pollen seasons and using air purifiers can help.

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

- Nasal Corticosteroids: These are effective in reducing inflammation in the nasal passages.

- Bronchodilators: If asthma is diagnosed, bronchodilators can help relieve bronchospasm and improve airflow.

3. Hydration: Staying well-hydrated can thin mucus, making it easier to clear from your airways.

4. Humidification: Using a humidifier can help keep the air moist, which may soothe irritated airways and reduce coughing.

5. Voice Care: Since your work relies on your voice, consider the following:
- Stay Hydrated: Drink plenty of water to keep your vocal cords lubricated.

- Warm-Up Exercises: Before speaking or performing, do vocal warm-up exercises to prepare your voice.

- Avoid Strain: Use a microphone if you need to project your voice, and take breaks to rest your voice.

6. Lifestyle Modifications: Avoid smoking and limit exposure to secondhand smoke, as these can exacerbate respiratory issues.

Conclusion
Persistent coughing can stem from various causes, including bronchial sensitivity, allergies, and post-nasal drip. A thorough evaluation by healthcare professionals, including allergists and pulmonologists, can help pinpoint the underlying issue. Once identified, appropriate management strategies can be implemented to alleviate symptoms and improve your quality of life. Additionally, taking care of your vocal health is crucial, especially given your reliance on your voice for work. If symptoms persist or worsen, do not hesitate to seek further medical advice.

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