Brief Answer:
Please give feedback and reports if done.

Detailed Answer:
Hi.
Thanks for your query.
To recapitulate: Male/62 - suffering from Chronic cough in the morning - severe pain in the liver area after evacuation in the morning - taking doxyphyline , deriphyline, salbair-i trans inhaler,pantocid ,levosulpride - wants suggestion for medicines ...

The list of the medicines indicate that you are being treated from occlusive bronchial disease like an asthma and GERD for the chronic cough.

Please give me some additional information:
- Since when have you got these problems?
- Have the medicines you are being given helped you and how much?
- Is there productive cough meaning any expectoration/phlegm?
- If yes, what is the consistency, quantity, color of the phlegm?
- Any complaints related to nose or sinuses in the form of sneezing, watering nose or blockage? Headache, fever chills?
- Any investigations like of blood and X-ray or CT scan of the chest and abdomen as you have complaints of pain in the abdomen on evacuation?
- Stool- consistency, loose or hard, color- black, yellow, clay, red or blood in stool?
- Any other abdominal symptoms like bloating, nausea, vomiting, eructation, lots of gas passing and relief of pain or so?
- Any other information you would like to share.

Your elucidate answers to these queries will help me to assist you better.

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Brief Answer:
As detailed below.

Detailed Answer:
Thanks for your feedback.
To recapitulate important points: GERD 2 years - *COPD 1 year - small quantity white phlegm - watery nose in the morning - tests mentioned normal except antral erosion - occult blood positive - bloating and epigastric pain in the morning - burning pain 5 pm ...

As you may know COPD is not curable hence the chronic cough and associated problems.
Precautions taken can help:
- Avoid all sort of allergens as much as possible- like pollen, dust, mites, gases, scents.
- Avoid sudden changes in temperature zones means not to get moved to the higher or lower temperature zones suddenly, give time for acclimatization.
- Get Vitamin D estimates and take therapeutic dosages of Vitamin A and D under the prescription of your Doctors. This combinations helps very much.
- Multivitamins by virtue of its anti-oxidant action helps good.
- Have proper hydration.
- Correct use of inhaler reduced the need for doxophylline , deriphylline which cause gastritis.


For the antritis and other problems:
Laxative in such a dose that keeps the bowel softer.
Continue Pantocid and Levosulpride for GERD and gastritis.
In addition:
- Avoid all the foods and beverages that you might have noticed to instigate or enhance your problems.
- Small frequent bland foods like breakfast, lunch, brunch by 5 pm and dinner.
- Walk around after dinner and sleep after hours.
- Stress and anxiety are the well known factors that increase both the problems you have. Control over is very important.
-Since your colonoscopy is normal, there is no possibility of cancer or so causing obstruction to the colon and pain in the morning. Hence another possibility is that it may be going into spasm while pushing feces down in the morning.
- Occult blood may be positive due to gastritis erosion.
- Take an opinion of a Pulmonologist and Gastroenterologist for proper clinical evaluation and investigations to get a proper picture and further advise.

Since the investigations for abdomen are normal, there is a possibility of IBS, that is irritable bowel syndrome.

I hope this answers your query, adds on some medications for very good long term effect, although the results may not be fast.

Awaiting your feedback after result

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