Chronic Cough and Asthma: Symptoms, Diagnosis, and Treatment

Q: Chronic Cough and Asthma: Symptoms, Diagnosis, and Treatment

Hello： The treatment provided by your physician is appropriate, but there may still be other factors that are not well controlled, such as dietary aspects. <br>Western medicine may not emphasize this as much, while traditional Chinese medicine will consider your constitution and

Chronic cough and asthma that have been troubling for a long time?

Hello Doctor: I have been coughing since mid-February of this year, and it has been over two months.
My symptoms include an itchy throat and trachea, coughing, and a lot of phlegm (all white and transparent foam).
Sometimes I feel a dull ache in my right chest.
In previous years, my symptoms would only flare up in the winter when the weather got cold, and they would naturally improve in the summer.
However, this year is strange; regardless of whether the weather is hot or cold, or whether it rains, I continue to cough.
At its worst, I have coughed to the point of feeling nauseous, which has severely affected my mood and daily life.
There have been several times when I felt like crying from the coughing… Over the past few months, I have gone to a large hospital for a chest X-ray, which showed normal results.
My blood test for IgE was only 46.39, which the doctor said is not high.
Allergy testing showed that I am allergic to dust mites with a score of 3 (I have been washing my sheets weekly).
A standard bronchodilator test was conducted, and the doctor noted that the difference in values before and after using the medication (which should be a bronchodilator) was not significant.
Although I have not reached the criteria for asthma, there are signs of mild obstruction (the doctor said it is not COPD and is reversible with treatment).
Therefore, I was finally diagnosed with mild persistent asthma and enrolled in a new asthma management care program.
I was prescribed medications including Budesonide, Salbutamol, Montelukast, and Formoterol, and I have been using inhalers and taking medication for two months.
I have the following questions, as I have not seen significant improvement and would appreciate your advice:
1.
My symptoms do not seem typical of asthma; I have never experienced wheezing or shortness of breath.
My coughing is not time-specific; it can happen at any time of day.
Sometimes I may not cough much during the day, but suddenly in the evening, I feel an itch in my trachea and start coughing with phlegm.
Interestingly, I do not cough at night when I am asleep, and I tend to cough less after exercising (such as hiking or using a fitness ring).
Typical asthma patients usually cough the most at night, in the early morning, and after exercise.
Am I truly experiencing cough-variant asthma, or do I need to undergo further testing?
2.
After receiving treatment at the hospital, my coughing symptoms have indeed improved to the point where I no longer cough to the point of vomiting, but I still experience an itchy trachea and phlegm daily, which is quite discouraging.
When I feel better, I can clear my throat, but when I feel worse, I still cough up a lot of phlegm.
Would you recommend trying a different medication or oral corticosteroids? Previously, when I took oral corticosteroids for a week, I saw immediate improvement, but I stopped because they cannot be taken long-term.
3.
Could the medications I am currently taking be causing tingling in my fingertips? Recently, I have started experiencing hand numbness and tremors, but they resolve after a night's sleep.
Thank you for your assistance, Doctor.
Although the current pandemic situation is severe, I will be returning to the hospital next week for a follow-up appointment to get my medication.
Thank you, Doctor.

Niming, 30~39 year old female. Ask Date: 2022/05/03

Dr. Yang Wenda reply Pulmonology

Hello: The treatment provided by your physician is appropriate, but there may still be other factors that are not well controlled, such as dietary aspects.
Western medicine may not emphasize this as much, while traditional Chinese medicine will consider your constitution and provide relevant recommendations.
It may be beneficial to consult with a Chinese medicine practitioner to understand what dietary and lifestyle factors you should pay attention to.

Reply Date: 2022/05/03

More Info

Chronic cough can be a frustrating and debilitating condition, especially when it persists for an extended period, as you have experienced. Your symptoms of throat irritation, persistent cough, and production of white, foamy sputum suggest that you may be dealing with a form of asthma, specifically cough-variant asthma. This type of asthma is characterized primarily by a chronic cough rather than the more typical wheezing or shortness of breath associated with classic asthma presentations.

Understanding Your Symptoms
1. Cough-Variant Asthma: It is not uncommon for individuals with cough-variant asthma to experience a cough that is triggered by various factors, including allergens, irritants, or changes in weather. The absence of wheezing does not rule out asthma; many patients may not exhibit this symptom. The fact that your cough can occur at any time of day and is not limited to nighttime or early morning is also consistent with this diagnosis.

2. Allergic Reactions: Your allergy test results indicating sensitivity to dust mites may also play a significant role in your symptoms. Allergens can exacerbate asthma symptoms, leading to increased coughing and mucus production. Regular cleaning and minimizing exposure to allergens can be beneficial.

3. Physical Activity: Interestingly, you mentioned that physical activity sometimes alleviates your cough. This could be due to the bronchodilating effects of exercise, which can temporarily open the airways. However, it is essential to monitor how you feel during and after exercise, as some individuals may experience exercise-induced bronchoconstriction.

Treatment Considerations
1. Medication Review: Since you have been on asthma medications for two months without significant improvement, it may be worth discussing a medication review with your healthcare provider. There are various classes of medications available, including inhaled corticosteroids, long-acting beta-agonists, and leukotriene modifiers, which may provide better control of your symptoms. If you previously experienced relief from oral corticosteroids, your doctor might consider a short course again, but this should be carefully managed due to potential side effects from long-term use.

2. Alternative Therapies: If your current medications are not providing adequate relief, you might want to explore other options, such as adding a leukotriene receptor antagonist (like montelukast) or adjusting your inhaled corticosteroid dosage. Some patients benefit from combination inhalers that include both a corticosteroid and a long-acting bronchodilator.

3. Side Effects: The tingling or numbness in your fingers could be related to several factors, including anxiety, medication side effects, or even a neurological issue. It is essential to discuss this symptom with your doctor, as they may want to evaluate your medications or conduct further tests to rule out other causes.

Next Steps
1. Follow-Up Appointment: Since you have a follow-up appointment scheduled, it would be beneficial to prepare a list of your symptoms, including the frequency and severity of your cough, any triggers you have identified, and the impact on your daily life. This information can help your doctor make more informed decisions regarding your treatment plan.

2. Consider Additional Testing: If your symptoms persist despite medication adjustments, your doctor may recommend further testing, such as a methacholine challenge test or a peak flow meter assessment, to evaluate your airway responsiveness and asthma control.

3. Lifestyle Modifications: In addition to medication, consider implementing lifestyle changes that can help manage your symptoms. This includes avoiding known allergens, using air purifiers, and maintaining a clean living environment to reduce dust mite exposure.

In summary, while your symptoms may not align perfectly with classic asthma presentations, they are consistent with cough-variant asthma. A thorough evaluation by your healthcare provider, along with potential adjustments to your treatment plan, should help you find relief. Remember to communicate openly with your doctor about your concerns and any new symptoms that arise.

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