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What Causes Cough And Need To Constantly Clear Throat?

Posted on Mon, 3 Mar 2014

Question: My husband has GORD. He has asthma but is currently having problems with a cough & the need to constantly clear his throat before he can talk. He has not had an asthma attack for 2 years. The excessive mucous & coughing up huge amounts of mucous is concerning me. Can it be related to Gord instead of asthma?

Answered by Dr. Saumya Mittal (1 hour later)

Brief Answer: this may be extraesophageal manifestation of GORD Detailed Answer: Hello XXXX I am Dr Saumya Mittal. And I will try to explain to you what is going wrong. Actually the possibility of both the conditions is strong as per the history you have mentioned in the query. I will agree with you that Gasrtoesophageal reflux disease, what you called as GORD, may be a possible cause of the problem. What happens is that the acid comes up to the esophagus, and from there it may come up to the neck while he is sleeping. This acid produces problems here and sometimes some of it enters the chest cavity causing asthma like features. Unfortunately there is no test that can really confirm this possibility. However it is usually considered that if the following tests help, the diagnosis can be confirmed. Please note that the steps are also the treatment steps for the conditions 1. try an antacid group that is called proton pump inhibitors. the medicines are like omeprazole, rabeprazole pantoprazole. Many times, these medicines are themselves sufficient 2. raise the head end of the bed by 3-4 inches. The patient thereby sleeps slightly angled. Make sure that the bed is not raised like in a sitting position. usually keeping 1-2 bricks below the legs of head end of the bed are sufficient 3. avoid drinking alcohol or coffee, especially 2-3 hours prior to bed. They relax the valve between the stomach and esophagus, allowing more acid to come out 4. gargles 2-3 times a day, especially immediately after getting up in the morning may help 5. avoid hot and spicy foods 6. drink lots of water 7 lead a stress free life I hope that information helps you. Make sure he keeps taking his asthma medicines. And I hope following these measures will help him Best wishes Looking forward to further query Dr Saumya Mittal MD

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Saumya Mittal (17 hours later)

I forgot to tell you that he takes Nexium for his GORD. He also has sudden choking fits, rarely when he is eating. They are more likely to occur when he is sitting relaxing. He will be reading or watching TV when he suddenly starts choking. He actually blacked out once - it must have been for several seconds as I heard him choking, then fall. I went looking for him but couldn't find him. I looked in all the rooms at one end of the house then was coming back & found him just climbing to his feet on the far side of the bed. That is the only time he has blacked out when choking. He really frightens me sometimes as he chokes for so long & goes so red I'm frightened he'll have a stroke. He won't let me touch him to assist him. He also has restless leg syndrome (which goes continuously all night) & sleep apnea which has not been officially diagnosed. However, I often count the seconds he doesn't breathe - usually 10-12 seconds, but the longest was 33 seconds. I'm having difficulty convincing him of the risks & the need to seek treatment. Typical man!!!! At least in Australia.

Answered by Dr. Saumya Mittal (4 hours later)

Brief Answer: Explaining further Detailed Answer: I can understand your exasperation. I face something similar at my home. And becomes even more frustrating since I know the possible problems that need to be evaluated. I am assuming he is taking Neksium only once a day. You can talk to his doctor and try it twice a day. Besides medicines like Sucralfate may help him further. For choking, I think it may be related to asthma more than GORD. You see what happens is that one feels one is unable to inhale air at the time of this episode. As the oxygen levels fall a person gets distressed and tries to move further where by the oxygen levels fall further. What can be done is you can put him on a nebulizer as soon as he starts having this choking problem. I am not sure what medicine he is using for asthma, but usually it is a hand held inhaler device. The flaw with this device is that it needs coordination and a deep breath, and he wont be able to do either when he is choking. In nebulizer, it comes out in vapours and he just has to keep breathing the vapors. I am guessing he is skipping his asthma medicines. That is the most common reason why this happens. So make sure he takes it. As for the Sleep apnea, the best possible management for that is via BiPAP support. It is a machine that can be used overnight. This machine makes sure that the breathing rate is supported. So you could probably talk to your insurance cover if they do help supply it. Waiting for further query from you Best of luck Dr Saumya Mittal

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Saumya Mittal (52 minutes later)

Thank you so much for your prompt replies. My husband did not develop asthma until he was 73. He is now 77. He has been choking since I met him 43 years ago. He is taking Nexium once a day & has just been directed to increase his asthma medication to lunch time as well as morning & night. He uses a spacer for his inhaler. I know about the BPAP machine, but that stubborn male thing means he's reluctant to go down that path, particularly as we travel quite a bit. He definitely does not miss his asthma medication - his trips to hospital with attacks mean that he is very particular about doing the right thing. Thank you once again. XXXX

Answered by Dr. Saumya Mittal (26 minutes later)

Brief Answer: About choking Detailed Answer: Hello again XXXXXXX The only alternative that I can think of is that he is probably allergic to something. Or he has sudden reflux that makes him choke. It wont be new for someone to have asthma with history of allergy, medically termed 'atopy'. I would suggest you check a serum IgE next time around a blood test. That would help confirm the idea of allergy. If its positive, then we can move for further options. If it is because of choking due to reflux, well he is already on treatment and I have mentioned how he can be treated further. Suggest a test of Serum Gastrin levels. The precautions and lifestyle modifications were mentioned in the very first communication. For convenience, I will mention them again- 1. try an antacid group that is called proton pump inhibitors. the medicines are like omeprazole, rabeprazole pantoprazole. Many times, these medicines are themselves sufficient 2. raise the head end of the bed by 3-4 inches. The patient thereby sleeps slightly angled. Make sure that the bed is not raised like in a sitting position. usually keeping 1-2 bricks below the legs of head end of the bed are sufficient 3. avoid drinking alcohol or coffee, especially 2-3 hours prior to bed. They relax the valve between the stomach and esophagus, allowing more acid to come out 4. gargles 2-3 times a day, especially immediately after getting up in the morning may help 5. avoid hot and spicy foods 6. drink lots of water 7 lead a stress free life As for as asthma and sleep apnea is concerned, I would suggest an ABG. Just to make sure that his Carbon diOxide and oxygen levels are ok. And I am always happy to help. Prompt is just an added habit. Best of luck. Hope to be able to help you again Dr Saumya Mittal MD

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Saumya Mittal (23 hours later)

Greetings Dr Mittal Thank you again for your prompt reply. You have certainly covered all the issues I raised. I think I have now persuaded my husband of the need to be reviewed by a Dr with a view to resolving the issues I am concerned about. As we intend to do quite a bit of travelling this year, some of which will be through some remote outback areas of Australia, then 3 weeks in New Zealand, it is important to get some answers and treatment to help him. Once again, thank you for your help. Regards XXXX

Answered by Dr. Saumya Mittal (12 minutes later)

Brief Answer: Best of luck Detailed Answer: glad to be of help XXXXXXX best of luck Dr Saumya Mittal

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Above answer was peer-reviewed by : Dr. Shanthi.E