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Suggest Treatment For Lingering Cough
Question: I have a lingering cough since two months. Doctor first treated for bronchitis. Was on antibiotics for couple of days. Cough didn't subside. After 3 weeks he asked me to get a chest xray and blood test done. Both came out as normal. He referred me to a pulmonologist. He did a spirometry test and the result came back normal. He said might be due to allergy and prescribed antihistamines and anti inflammatory tablets for a month. Cough has come down. But I still cough. But when I do cough I end up gasping for air. Otherwise I Dont have congestion or wheezing or difficulty breathing. I used to smoke. But have stopped since I got my cough about 2 months back. My pulmonologist tested for copd during spirometry. Dont know how long I need to completely get back to normal.
Brief Answer:
It is current episode of bronchitis.
Detailed Answer:
Hi,
Thanks for posting the query on HCM. After going through your query, I would like to comment the following:
1. You currently have cough since 2 months.
2. Do you have any known allergies like allergy to dust? Do you have associated cold, burning pain in abdomen, bloating, ? Do you snore during sleeping? Since how long have you been smoking and how many cigarettes did you smoke per day? Do you have phlegm production with cough? Does cough come at any time of the day or is it just at a particular time? Have you noticed any seasonal variation of the symptoms? any significant medical history in the past? What is your occupation? Any significant family history? Are you currently on any medications / inhalers? Was the spirometry test absolutely normal? Any recent history of long travel?
3. Please do let me know the above info so as to let me evaluate your history in a more specific way.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
It is current episode of bronchitis.
Detailed Answer:
Hi,
Thanks for posting the query on HCM. After going through your query, I would like to comment the following:
1. You currently have cough since 2 months.
2. Do you have any known allergies like allergy to dust? Do you have associated cold, burning pain in abdomen, bloating, ? Do you snore during sleeping? Since how long have you been smoking and how many cigarettes did you smoke per day? Do you have phlegm production with cough? Does cough come at any time of the day or is it just at a particular time? Have you noticed any seasonal variation of the symptoms? any significant medical history in the past? What is your occupation? Any significant family history? Are you currently on any medications / inhalers? Was the spirometry test absolutely normal? Any recent history of long travel?
3. Please do let me know the above info so as to let me evaluate your history in a more specific way.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello,
1. Yes the cough started 2 months back.
2. Yes I am allergic to dust and pollen. I have been treated for allergic rhinitis previously. In past doctor has asked me to carry montelukast tablets incase I start sneezing due to allergy. I currently do not have cold or burning pain in abdomen or bloating. Yes I snore while sleeping. Its been around 8 years since i started smoking and i have usually i smoke only 3 to 4 cigarettes a day and on social occasions I smoke around 8-9 cigarettes a day and on some days i usually dont smoke. Phelgm is produced but not much. its always clear in color. I usually cough when i am awake. I dont cough when i am asleep. I have observed i cough as soon as i wake up. Then I cough at irregular periods without any consistent timings. The only medical history is sneezing due to allergy. As soon as I take montelukast the sneezing stops. I work as a games developer. Allergy runs in the family. Father, Mother and sister all have allergies same as mine. I am current not using any inhalers. My current doctor has prescribed one tablet of Telekast tablet at night. 1 tablet of Defnalone-6 every morning. Even though the cough has reduced it still persists. But when i do cough i end up gasping for air. The following are the spirometry values:
FVC - %Pred - 89
FEV1 - %Pred - 93
FEV1/FVC - PRE - 87.3 and %Pred - 103
PEF - PRE - 11.47 and %Pred - 121
FEF2575 - %Pred - 96
Before the cough started I was on a weeklong holiday in Thailand.
Thanks and Regards,
XXXX
1. Yes the cough started 2 months back.
2. Yes I am allergic to dust and pollen. I have been treated for allergic rhinitis previously. In past doctor has asked me to carry montelukast tablets incase I start sneezing due to allergy. I currently do not have cold or burning pain in abdomen or bloating. Yes I snore while sleeping. Its been around 8 years since i started smoking and i have usually i smoke only 3 to 4 cigarettes a day and on social occasions I smoke around 8-9 cigarettes a day and on some days i usually dont smoke. Phelgm is produced but not much. its always clear in color. I usually cough when i am awake. I dont cough when i am asleep. I have observed i cough as soon as i wake up. Then I cough at irregular periods without any consistent timings. The only medical history is sneezing due to allergy. As soon as I take montelukast the sneezing stops. I work as a games developer. Allergy runs in the family. Father, Mother and sister all have allergies same as mine. I am current not using any inhalers. My current doctor has prescribed one tablet of Telekast tablet at night. 1 tablet of Defnalone-6 every morning. Even though the cough has reduced it still persists. But when i do cough i end up gasping for air. The following are the spirometry values:
FVC - %Pred - 89
FEV1 - %Pred - 93
FEV1/FVC - PRE - 87.3 and %Pred - 103
PEF - PRE - 11.47 and %Pred - 121
FEF2575 - %Pred - 96
Before the cough started I was on a weeklong holiday in Thailand.
Thanks and Regards,
XXXX
Brief Answer:
You need further evaluation.
Detailed Answer:
Hi,
Thanks for the information. After going through your history, I would like to comment the following:
1. You seem to be an atopic individual with recurrent allergic rhinitis which could have led to upper airway cough syndrome. Your Pulmonary function tests are normal at present but the cough seems to be a result of mixed effect of allergy and smoking. One of the things that need to be done in spirometry is the reversibility testing or the "post" values to rule out hype responsive airways.
2. On days of allergic rhinitis - nasal sprays can be added to your prescription as well as antihistaminics (anti allergy ) medications.
3. Investigations that will be of help are - spirometry reversibility testing, complete blood count, peripheral smear, serum IgE levels, sputum examination - afb, gram stain and culture, and cytology.
4. Since you have snoring- that can lead to dry mouth and coughing as well. If required an overnight sleep study can be done to rule out any obstructive sleep apnoea syndrome.
5. The possibility that this is early smoker's cough also needs to be considered and if such is the case then it will take time to subside. Its high time that you stop smoking. If required you may attend a smoking cessation program.
6. If required an oral inhaler may be added for gasping of breath during coughing. Normally a 2 to 3 weeks course of antibiotics is sufficient to treat an episode of secondary infection. Remember defnalone 6 mg is a short term medication and cannot be used on a long term basis in your case.
7. Thus continue your follow ups with pulmonologist and you may get evaluated as mentioned above.
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
You need further evaluation.
Detailed Answer:
Hi,
Thanks for the information. After going through your history, I would like to comment the following:
1. You seem to be an atopic individual with recurrent allergic rhinitis which could have led to upper airway cough syndrome. Your Pulmonary function tests are normal at present but the cough seems to be a result of mixed effect of allergy and smoking. One of the things that need to be done in spirometry is the reversibility testing or the "post" values to rule out hype responsive airways.
2. On days of allergic rhinitis - nasal sprays can be added to your prescription as well as antihistaminics (anti allergy ) medications.
3. Investigations that will be of help are - spirometry reversibility testing, complete blood count, peripheral smear, serum IgE levels, sputum examination - afb, gram stain and culture, and cytology.
4. Since you have snoring- that can lead to dry mouth and coughing as well. If required an overnight sleep study can be done to rule out any obstructive sleep apnoea syndrome.
5. The possibility that this is early smoker's cough also needs to be considered and if such is the case then it will take time to subside. Its high time that you stop smoking. If required you may attend a smoking cessation program.
6. If required an oral inhaler may be added for gasping of breath during coughing. Normally a 2 to 3 weeks course of antibiotics is sufficient to treat an episode of secondary infection. Remember defnalone 6 mg is a short term medication and cannot be used on a long term basis in your case.
7. Thus continue your follow ups with pulmonologist and you may get evaluated as mentioned above.
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. Bhagyalaxmi Nalaparaju
Answered by
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