Persistent Coughing: Symptoms and Seeking Solutions

Persistent cough?

Hello Doctor: I accidentally caught a cold at the end of February this year, and I have been coughing since then.
I underwent numerous tests at a major hospital, and the most recent chest X-ray was taken in early May to check for airway allergies, which showed normal lung function.
Blood tests indicated a slightly elevated white blood cell count in my immunoglobulin levels, but no other allergens were found.
An ENT specialist also examined me and ruled out the possibility of post-nasal drip and gastroesophageal reflux.
Subsequently, the doctor prescribed medication for bronchial asthma symptoms, which improved my nighttime coughing, even to the point of vomiting, but I still experience intermittent coughing during the day.
At least my sleep at night has improved.

Recently, I noticed a continuous weight loss from early March until now, dropping from 60 kg to 51 kg.
My appetite is somewhat poor, but I can still manage to eat about 70% of my usual portion.
Since the end of April, I have experienced chest or back pain from coughing for the fourth time.
This time feels different; the pain seems to radiate from my chest to my back, and I have some soreness in my right shoulder.
Additionally, I feel quite fatigued every day.
I am unsure what is happening to me.
The doctor mentioned that since I had an X-ray taken in early May, it is unlikely that there are any lung issues, and suggested that it might be a thyroid problem, but I have not yet had blood tests for that.
May I ask if having an X-ray in May means that there should not be any issues now? Should I disregard these uncomfortable feelings?

Sarah Wang, 30~39 year old female. Ask Date: 2001/07/10

Dr. Zhang Zhengda reply Pulmonology

Persistent cough accompanied by chest and back pain requires attention.
It is advisable to seek consultation with a pulmonologist for further evaluation and treatment.

Reply Date: 2001/07/10

More Info

Persistent coughing can be a frustrating and concerning symptom, especially when it lingers for an extended period. Based on your description, it seems that you have undergone a thorough evaluation, including chest X-rays and blood tests, which have ruled out some common causes of chronic cough. However, your ongoing symptoms, including weight loss, fatigue, and pain associated with coughing, warrant further attention.

Understanding Your Symptoms
1. Chronic Cough: A cough that persists for more than eight weeks is considered chronic. It can stem from various causes, including postnasal drip, asthma, gastroesophageal reflux disease (GERD), chronic bronchitis, or even more serious conditions like lung infections or malignancies. Since your tests have ruled out some of these, it’s essential to consider other possibilities.

2. Weight Loss: Unintentional weight loss, especially when coupled with chronic cough and fatigue, is a red flag. It can indicate underlying health issues, including infections, malignancies, or metabolic disorders. Even if your appetite is relatively normal, the weight loss should be investigated further.

3. Chest and Back Pain: Pain that radiates from the chest to the back during coughing can be due to muscle strain from frequent coughing or could indicate irritation of the pleura (the lining of the lungs) or other thoracic structures. However, it’s crucial to rule out any serious conditions that might cause such pain.

4. Fatigue: Chronic fatigue can be multifactorial. It may be related to your persistent cough, sleep disturbances, or even an underlying condition that has not yet been diagnosed.

Next Steps
Given that your recent X-ray was taken in May, it does not entirely rule out the development of new issues since then. Conditions can evolve, and new symptoms can emerge. Here are some recommendations for your next steps:
1. Follow-Up with Your Doctor: It’s essential to communicate your ongoing symptoms, especially the weight loss and fatigue, to your healthcare provider. They may recommend further tests, such as a CT scan of the chest, to get a more detailed view of your lungs and surrounding structures.

2. Thyroid Function Tests: Since your doctor mentioned the possibility of thyroid issues, it would be prudent to have your thyroid function tested. Thyroid disorders can significantly impact metabolism and energy levels, contributing to weight loss and fatigue.

3. Pulmonary Function Tests: If you haven’t already undergone these, they can help assess for asthma or other obstructive lung diseases that might not be evident on an X-ray.

4. Consider a Referral: If your symptoms persist without a clear diagnosis, consider asking for a referral to a pulmonologist (lung specialist) or an internist who can provide a more comprehensive evaluation.

5. Lifestyle Modifications: While awaiting further evaluation, ensure you maintain a balanced diet to support your health. Staying hydrated and avoiding irritants (like smoke or strong odors) can also help manage your cough.

Conclusion
In summary, while your previous tests have provided some reassurance, the persistence of your cough, weight loss, and fatigue are concerning and should not be ignored. It’s crucial to continue seeking answers and advocating for your health. Regular follow-ups and open communication with your healthcare provider will be key in addressing your symptoms and finding an appropriate treatment plan. Remember, your health is paramount, and addressing these symptoms early can lead to better outcomes.

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