Suffering From Mild Cough. Diagnosed With Allergy. Noticed Blood In Cough And Getting Acid Reflux

Posted on Thu, 18 Apr 2013

Question: Hi doctor,
My brother is suffering from mild cough for past 8 months or so. When he showed to doctors they said that he has an allergy. He had an x-ray done 4 months back and doctors said its just an allergy. Gradually he started eating an ayurvedic medicine around 1 month back and cough subsidized a lot. But, suddenly yesterday, when he woke up, then he had blood in the cough. Also, today as well he had little blood in the cough after he coughed a lot. He also says that he always feels like there is something stuck in his throat and today he saw some white chunks as well, in the sputum. He is not coughing a lot just some irritation and coughs very lightly. But, this thing is really worrying. For last few days he's also reporting of a lot of acidity and reflux and pain in stomach.
Please suggest.

Thanks and Regards
XXXXXX

Answered by Dr. Gyanshankar Mishra (3 hours later)

Hi,
Thanks for posting the query on XXXXXXX After going through your query, I would like to comment the following:

1. Your brother is having cough with hemoptysis. He also has associated GERD (Gastro esophageal reflux disease).

2. He needs to be evaluated by a Pulmonologist in detail. Investigations that may be required in addition are blood investigations, sputum investigations, HRCT scan thorax and bronchoscopy.

3. He will require a course of antibiotics, hemostatics, cough suppressants and anti acidity medications.

4. Detailed evaluation is thus required for his further management.

5. Possibilites at this stage include infective etiologies like TB, pneumonia, bronchiectasis. Also there may be GERD induced cough associated.

6. Please get his evaluation done by a Pulmonologist as soon as possible.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (4 hours later)

Hi Doctor,

He went to a hospital yesterday and got his checkup done. The doctor asked for following tests:
1) Chest X-Ray
2) Some pulmonary test where he had to blow some air.
3) Blood Test
4) Sputum test with morning Sputum for 3 days.
5) Some Enzyme Test.

Out of The X-Ray, Pulmonary and Blood Test reports came today and Doctor says that all of these are normal. And now awaits the Sputum report on Tuesday.

Also, Today in the morning, he did get some blood in the cough after he tried coughing for a long time. Also, he got some solid white particles from throat, which were very smelly.

I hope everything is normal. Can you suggest anything here?

XXXXXX

Answered by Dr. Gyanshankar Mishra (19 minutes later)

Hi,

Thanks for the follow up.

1. Considering his Xray, blood test and pulmonary function test to be normal along with symptom of hemoptysis at present, further evaluation in the form of HRCT scan thorax and bronchoscopy are required. Also sputum reports are important. However with a normal Xray, sputum report might be normal.

2. Thus further evaluation with a Pulmonologist is required.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (1 hour later)

Is it something serious?

Answered by Dr. Gyanshankar Mishra (3 hours later)

Hi,

Thanks for the follow up.

Considering the normal investigations till now it does not seem to be something very serious at present, but it definitely needs to be evaluated at the earliest.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (4 minutes later)

Thank you doctor, It lowered a lot of tension from my mind. I'll keep u posted with his other reports for few days.

Answered by Dr. Gyanshankar Mishra (11 minutes later)

Hi,

Thanks and Regards,

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (2 days later)

Hi Dr,

My brothers Sputum test reports also came as normal. So, for now below is the history:
1) mild cough for last 8 months without much mucus.
2) Allergy Medicines taken in last few months, and cough suppressed, but, would resurface.
3) X-Ray done 3 months ago >> Normal
4) Blood in morning cough few days back (very small amount in the consecutive days)
5) Latest X-Ray >>> Normal
6) Breathing Test for Bronchitist and Asthama >> Normal
7) Sputum Test >> No Bacilli found.

The Doctor there advised him to go to a Gastro Specialist.

Can you suggest anything on this?

Thanks and Regards,
XXXXXX

Answered by Dr. Gyanshankar Mishra (35 minutes later)

Hi,
Thanks for the follow up.
After going through the reports, I would recommend the following:

1. HRCT scan thorax and bronchoscopy are indicated.

2. Please consult a Pulmonologist for above investigations and clinical evaluation since the patient has predominantly chest symptoms.

3. A gastroenterologist opinion for reflux symptoms will help.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
4. If the above investigations are also normal then the diagnosis could be GERD induced cough and patient needs to take antacids for the same.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (17 minutes later)

Hi Doctor,

Thank you for your answer,
The doctor who advised all these tests to my brother was some Pulmonary Specialist in Pune, India.
And later he asked him to go to a gastroenterologist, who further has asked to do Endoscopy tomorrow.
Also, the same doctor has asked him to visit his clinic after 1 week.
So, I'll ask my brother to talk to him about HRCT scan thorax and bronchoscopy.
If, there is anything else, you'd like me to tell him to focu on, then please let me know.
Thanks for all the help till now.

Thanks and Regards,
XXXXXX

Answered by Dr. Gyanshankar Mishra (23 minutes later)

Hi,

1. As far as the chest complaints are concerned, bronchoscopy and HRCT Scan thorax will suffice to pick up any abnormality.

2. Endoscopy by gastroenterologist will definitely pick up the grade of reflux if any.

3. Once the diagnosis is established, the medications need to be given accordingly.

4. If the above investigations are also normal then the diagnosis could be GERD induced cough and patient needs to take antacids for the same.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar