Brief Answer: Possibly due to Gastro-oesophaeal reflux Detailed Answer: Namasthe Welcome to Healthcare-Magic Greetings of the day Dear XXXX Going by the history provided by you, its likely that cause of recurrent cough could be possibly due to Gastro-Oesophageal reflux leading on to hyperactive airway disease. Especially if its associated with nocturnal coughing and no sputum. As you have no other associated complaints like fever, weight loss, it rules out infective etiology. Your Chest X ray looks fine, with no gross lesion seen . You will require reassessment and thorough re-evaluation of the symptoms I would suggest you the following which will surely help in guiding you the further course of management 1. Finding out Etiology for chronic recurrent cough: You will require Upper Gastro-intestinal contrast study and Upper Gastro-intestinal Endoscopy to document gastro-oesophageal reflux. Cough could also be seen in asthma variant, but it does respond to asthma medication. In your case you have not responded to it, which makes it less likely as cause of your symptoms. 2. Consume small quantity frequent meals-- it reduces the amount of reflux and relaxation of lower Oesophageal sphincter 3. Avoid the following( These cause increased transient relaxation of lower oesophageal sphincter promoting gastro-oesophageal reflux): Caffeine/carbonated beverage/ Nicotine/ Alcohol 4. Steam Inhalation: Taking Steam inhalation 15-20 minutes every session 2 - 3 times a day will also be helpful. 5. I would also suggest you addition of gastric motility increasing drug like Domperidone in addition to proton pump inhibitors you may taking. I would suggest you to consult your Physician and discuss these probability and plan the things further from here. Wetting of pants is sometimes commonly seen in woman with chronic coughing and is likely to be Stress incontinence( urinary leakage occuring following any procedure like coughing which increase the intra-abdominal pressure). Treatment of cough should lead to resolution of this complaint. I Hope it helped. In case you need any further assistance, will be glad to assist you. Take Care Wishing you a speedy recovery Wishing you and your family a very Happy New Year 2014. Best Regards Dr Deepak Kishore MBBS,MS,MCh Consultant Surgeon

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Brief Answer: Thorough re-evaluation by Pulmonologist Detailed Answer: Greetings GERD could have variety of presentation. It could be any of the following 1. Retrosternal burning pain, belching 2. Bitter taste in mouth and dental carries 3. Persistent cough 4. Asthma like presentation I have just suggested one of the possibility in your case. Looking at your chest X ray there does not seem any infective foci. Even then following possibility should be considered and ruled out in cases of chronic cough 1. Asthma 2. Gerd 3. Infective. Etiology like Tuberculosis I would suggest you thorough evaluation by Pulmonologist. In the meantime follow the advice which I jag mentioned earlier. Also presence of blood in the cough requires thorough evaluation by Pulmonologist at earliest. I hope it helped In case you require any further assistance, will be glad to assist you. Take care Best Regards Dr Deepak Kishore MBBS, MS, MCH

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