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Chronic Cough Workup, Part II
What follows is a description of the diseases which cause a chronic cough and a summary of how the test results are used to determine the diagnosis and the treatment.
Classic asthma causes intermittent episodes of wheezing with chest tightness, shortness of breath, and cough. When the patient is currently having such an episode, spirometry demonstrates airway obstruction (a low FEV1/FVC) and airflow improves within 15 minutes (FEV1 increases more than 12%) after inhaling a couple of puffs of albuterol (a bronchodilator which is much stronger than caffeine). If the patient has recovered from the symptoms previously experienced, then spirometry may be normal and a methacholine challenge test (MCT) will demonstrate twitchy airways (bronchial hyper-responsiveness, BHR) due to the airway inflammation in the lungs.
Other tests of airway inflammation which help to confirm typical asthma are increased eosinophils (white blood cells which respond to allergens) in the blood and induced sputum, and an increased concentration of nitric oxide in the exhaled breath (eNO >30ppb). Despite a chronic cough, the cough reflex sensitivity (CRS) of patients with asthma is usually normal (although it's rarely measured). The treatments most likely to be effective for asthma are inhaled corticosteroids (ICSs) and long-acting bronchodilators (LABs). Singulair pills (monteleukast) also successfully reduce airway inflammation in about one-fourth of patients with mild asthma.
Cough-variant asthma (CVA, not to be confused with a stroke) is just like mild classic asthma except that nobody has heard any wheezing (yet). All of the lab test results are like classic asthma, but on the average, the results suggest less severe airway inflammation. CVA treatments are identical to those for classic asthma. About one-third of patients with CVA develop classic asthma with wheezing during the next several years. Patients with CVA are often frustrated because they have been told that they don't have asthma because nobody can hear them wheeze and their spirometry test results are usually normal. Read the book "Breathless" by Louise DeSalvo for a typical story of such a patient.
Chronic Cough Workup, Part I
Chronic Cough Workup, Part III
Related Topics: Heartburn and Asthma, Controlling Your Asthma
Classic asthma causes intermittent episodes of wheezing with chest tightness, shortness of breath, and cough. When the patient is currently having such an episode, spirometry demonstrates airway obstruction (a low FEV1/FVC) and airflow improves within 15 minutes (FEV1 increases more than 12%) after inhaling a couple of puffs of albuterol (a bronchodilator which is much stronger than caffeine). If the patient has recovered from the symptoms previously experienced, then spirometry may be normal and a methacholine challenge test (MCT) will demonstrate twitchy airways (bronchial hyper-responsiveness, BHR) due to the airway inflammation in the lungs.
Other tests of airway inflammation which help to confirm typical asthma are increased eosinophils (white blood cells which respond to allergens) in the blood and induced sputum, and an increased concentration of nitric oxide in the exhaled breath (eNO >30ppb). Despite a chronic cough, the cough reflex sensitivity (CRS) of patients with asthma is usually normal (although it's rarely measured). The treatments most likely to be effective for asthma are inhaled corticosteroids (ICSs) and long-acting bronchodilators (LABs). Singulair pills (monteleukast) also successfully reduce airway inflammation in about one-fourth of patients with mild asthma.
Cough-variant asthma (CVA, not to be confused with a stroke) is just like mild classic asthma except that nobody has heard any wheezing (yet). All of the lab test results are like classic asthma, but on the average, the results suggest less severe airway inflammation. CVA treatments are identical to those for classic asthma. About one-third of patients with CVA develop classic asthma with wheezing during the next several years. Patients with CVA are often frustrated because they have been told that they don't have asthma because nobody can hear them wheeze and their spirometry test results are usually normal. Read the book "Breathless" by Louise DeSalvo for a typical story of such a patient.
Chronic Cough Workup, Part I
Chronic Cough Workup, Part III
Related Topics: Heartburn and Asthma, Controlling Your Asthma
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35 Comments:
I am looking for any and all information about bronchiactasis and pseudomonis that a lay-person can understand. E.G. what exactly are these diseases? Do they (always) occur together? What factor does stress play in their onset/recurrence? Does pseudomonis cause an eventual filling of the lungs? What are some natural therapies for prevention? Is there ever a real cure?
Sorry I can't help you but I have the same thing and would also like to know more.
I have bronchiectasis and am told I have pseudomonis and would like to know if there is any drugs to control this situation.
pseudomonis is found in soil and water everywhere. It only affects people already unwell. I have a chronic lung condition and pseudomonis made me very ill. Ciproxin cleared the pseudomonis for me. Ciproxin made me feel very depressed but worth putting up with that for a couple of weeks to clear the pseudomonis.
Further to my comments 1.16am Met woman at lung clinic. OOOh cannot clear my pseudomonis it has colonised. That was it for her, she was keeping it. I also told my body while taking Ciproxin.....I don't want pseudomonis in my body, it's my body don't let it propigate. Visualise and watch it shrivel or send pacman in to munch it up.
my husband has had a chronic cough for almost 2 months and cannot get rid of it. he has been to the doctor 4-5 times and it still does not get better does anyone know anything that might help?
My dad has had a chronic cough for more than 5 months, often coughs up a clear sputum, and experiences severe chest pain while coughing..any ideas what it is?
My dad has had a chronic cough for more than 5 months,had pneumonia about 3 months ago,he often coughs up a clear sputum,and some blood.no pain or other signs of sickness. any thoughts?
I was diagnosed with chronic bronchitis and eventually Bronchiectasis many years ago...I now have pseudomonis in my lungs for about a year and no antibiotics have cleared up my chronic cough. I usually end up in bed with low grade fever, chills and no energy with inflamed lungs....if I literally lay down for a few days, the coughing subsides and I can go back to work...only thing I have found that helps at home is Mucinex (otc) to loosen congestion in lungs and lots of Advil. I have a bronchoscopy done at least once a year to determine what type of bacteria is now invading my damaged lungs.
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My mother has pseudomonis affecting her lungs and after different treatment now takes Gentamicin(mucodyne) by nebuliser daily. This is available as a syrup, which may be prescription only but not sure if this is as effective.
I been diagnosed with "Minimal Bronchiectasis and Chronic Fibronodular changes", how serious is my diagnosis?
I have had tightness in my chest since leaving ark over 5 months. I do have chronic severe asthma, in addition i have this chronic cough that is affecting my ears. So it hurts hella badly to swallow, and to top it off i have type 2 diabetic and my sugars are real high. So whats normal for me with nothing on my stomach is my blood sugars are most of the time 239.
So I need some help?
My husband is a farmer and is 50 years old. He has had a chronic cough and wheezing for weeks and cannot get over it. His eyes also burn, should I be concerned?
I too have had a cough deep in my that started in my right lung a month ago. It felt like something that needed to be coughed up, now it has spread to both lungs and I have coughed so hard ever since. My doctor gave me a Z pack and polytussin, then biaxin and polytussin, now prednisone, but that is up in two days. They are not taking it seriously because they say my xrays are clear?? Help. In addition my older sister just died from a similar "lingering cough". Whats up??
About 10 years ago I had a chronic cough a lot like you are describing. I coughed so hard and so much that I pulled muscles in my back and later cracked two ribs. Just from coughing. It all began as just a nagging little tickle in my throat that later felt like my lungs were on fire. I had a low fever periodically, and a pretty good one once, but not the whole time. I went to five doctors over six months and took six or seven different meds and had several different shots. Finally a Dr at an Urgent care place in Austell thats not there anymore, did some type of test I can't remember (I was so out of it by that point) and called everywhere I had been and read everyone's notes. He said that what I had was a sort of cousin to TB, and if I had not gotten the right treatment, it would never had gone away. It would've just slowly eaten me up. He gave me a couple of meds, and in a couple of weeks, I was as good as new. I remember that the name of it was two or three letters/initials, but I have no idea what it was called. I am so sorry, but maybe this will help some of you anyway! :) I hope that it does. Good luck. My prayers are with you. :)
Oh, and beyond that, if your Dr won't take you seriously and your gut tells you there is something wrong, get a new Dr!! That's my advice! :) You deserve better!
my daughter has had a cough for the past 3 years. she has been to all kinds of Dr.s and still no clear answers. Her x-rays always come back clear.She has a breathing machine and she takes xopenex in it, but it does not work on her. Can anyone out there help me? Thank you in advance.
I've had a constant tickle in my throat for over 2 months. Been on antibiotics and cough meds. No help. My doctor just told me that a lot of blood pressure medicine cause the tickle in the throat, so he has changed my bp medicine. It's getting better!! Just a thought for some of you.
My cough is five years old. Doctors see a clear x-ray and shrug their shoulders. One of them said, all of us cough. The only thing that works seems to be a
-tussin cough syrup but it's a narcotic and they are reluctant to prescribe it. It seems to break the cycle for several days and I can stop it for awhile. Since diagnosis eludes the mds, I would settle for treating the symptom. Embarrasing, it is so loud sometimes.
We bought a house that we later found was infested with deadly toxic molds which I was allergic to and almost died from (back in 2001). Since then my heath has rapidly declined. Continued lung infections, contstant asthma attacks, chronic bronchitis 2-3 times a year. Now I got bronchitis in January of 08 and I have not been able to get better. I have a cough that will not go away, it settles some when I'm resting quietly, when I move around I get completely out of breath. I had a bronch in May where they removed "Fungus, staff, infection and fluids from my lungs." last week (7/6) my dr did another bronch and again removed more fungus, fluid and infection which he did not expect to find. Now he says that he does not think that I even have asthma, copd or empyzema (I've never smoked). I feel like no one believes me, I'm so scared and tired of not being able to breath and of hurting all the time. My husband tells me it is just because I'm out of shape but just trying to walk leaves me breathless and coughing, this pulmonary dr was my only hope now I don't know where to go or to help... does anyone know what I can do? All the drs end up trying to say it is acid reflux and giving me meds for that and it makes absolutely no difference... Please can someone help, guide me??? Barbie
33% OF ADULTS WITH A CHRONIC COUGH THAT LAST AND LAST - HAS PERTUSSIS"WHOOPING COUGH" THAT WAS THE CASE OF MY SISTER, WHO ENDED UP GIVING IT TO MY DAUGHTER, WHO IS AN INFANT - WHICH COULD HAVE BEEN FATAL!!!! BE AWARE!!!!! ASK YOUR PHYSICIAN ABOUT THAT!
I cleaned up an older mobile in coastal town of OR and got into some very bad mold and fungus. Thinking that I only was comming down with cold symptoms,I went only three days and very nearly stopped breathing altogether. ER said oxygen level was at coma stage. Remained 4 days in Hosp.to get oxy level back to 90. There is NO CURE AT THIS TIME for this and it will always be there! I moved to a dryer climate to help keep it from growing wild again! The pain is horrible and the cough and mucus is constant. Only prednisone and antibiotics will help. Many people have this in lungs undiagnosed and it will KILL! GET A GOOD DOCTOR and tell him you want to live!
what u do for a chronic cough all the time 3 months today i cant take i am on some may meds dont wrok been at hopstapl for 2 weeks they know was werog
In answer to Shiela: I played around with local Dr.'s including pulmonologist, one z-pack after another, one antibiotic after another. My best Advice: Call & go to either Mayo Clinic or Research Hospital in Denver. These are the top 2 pulmon. medical facilities in the U.S. By the time I got to Mayo, (they diagnosed me on the first try). Medical community has NO data on whether pseudo. can ever be completely eradicated from lungs. It is an opportunistic bacteria, (found all around us) and many people contract it but not in the lungs! Cold weather is a severe problem (pain in the lungs)
And when you have these, you are more likely to develop pneumonia. Re info on bronchiectasis: these two institutions can help - basically, the reactiveness of your bronchial tubes have been damaged. They do not react (open/close) correctly, and one result is that mucus can accumulate; great bacterial medium, thus more complications.
someone sugggested mucinex, this can help & one tab has a cough supress. in it. The rest is about seeing the experts. Nothing is more important - go!
My husband and I have both had this severe cough for 8 and 6 weeks respectivaly. He has had a chest x-ray, I have had a Cat scan and nothing shows up. We have been through 3 rounds of antibiotics and steroids each plus inhailers with no results.
At night we cannot get any air and feel as if we are going to stop breathing as no air will go into our lungs.Very scarry!
It all started the day after he was mowing weeds in a field of ours. I would love to find out how to correct whatever it is that we have.The Dr. is baffled.
after 4 months of torture and 13ER visits for a horrible cough that led to dizziness, passing out, vomiting, and complete inability to get out of bed, I was tested for Pertussis "whooping Cough" and test came back positive...you have to be tested specifically for it...even a year later, my lungs still arent "right" I still get real bad colds that go right to my chest, and I have never gotten rid of that cough...hope this helps...also I am a 34 year old healthy woman...
I was hospitalized two month ago with chronic Pneumonia. While i was in the hospital and since i was released two mos. ago, I have had this constant nagging congestive cough and spitting up phloem all
day and it's worse at night and i can't sleep. The Hospital is putting me threw a series of test, but no solutions. No type of percription has been perscribed. Can anyone suggest anything
Response to Barbie, who bought the house infested with mold - first,healthwise,definately explore the possibility of bronchiactasis with your doctor. I think my friend needed to see several lung specialists, over a course of years of coughing,before one identified it properly. Perhaps with a "heads-up" it might speed the process. Legally, check into the possibility of suit. Each states laws are different, but many have laws against selling with undisclosed dangers, even if the owner claims not to know of them. Check it out.
This is in response to Jessie. For the last two years I have had a chronic cough and have been in and out of the doctors offices weekly. I missed four months of school last year and pretty much lived on my nebulizer, which I took xopenex and pulmicort from twice to three times daily. I'm on Singular, Prevacid, Tessalon Pearls, Nasonex and Clariton. I still take pulmicort twice a day on my nebulizer. Blog back and communicate with me because I dont know what is wrong and none of my doctors have been a help.
I've had this since birth. the fits last 20 seconds-2 minutes, my face gets read, i can't breathe. I don't have to be doing anything. it happens when i am drinking. it happens when I am not eating. it happens when i am eating. it happens when I am just sitting there. the coughs went away once i became a regular smoker. I quit smoking and the coughs came back. I was a regular smoker from age 21-27. i've had these fits for as long as I can remember. the only pattern i've been able to find is commonly occur when i wake up. but they occur at other times too. the other times are random. it could happen if I'm inhaling. People try to tell me to take a drink of water or a liquid and they don't understand it makes it worse. and makes it even harder to breathe when I already can't breathe. I have CP and I had a (non cosmetic) cleft palette operation when i was 5. I had a lot of ear infections as a child and had tubes in my ears too. I had waxy ears and have to do an ear drop regimen. my ears don't get the ringing as much as they used to, but i still get the ringing in them. The inner ear canal often itches too. I do not wheeze. it just feels I have something i need to cough up even if I've not digested anything at all. And I don't understand why smoking would make it go away completely.
to the person who quit coughing when they smoked - Me Too! I had the cough ever since I was a kid. I started smoking, then whenever the cough hit, I lit a cigarette and I stopped coughing. I know that this is the most stupid thing on earth. Now, I'm 50 - smoking is not accepted. I'm in a place where I can't smoke, and think - oh God, I hope that I don't cough - and there I go - coughing my head off. I'm scared to go to the dr. I don't want to hear, Lung disease that I caused to myself.......anybody have any otc, or holistic help - and any ways to quit the nicotine? chantix makes me suicidal, patches, gum, hyptnosis don't work
to barbie and john, i am 19 years old and was diagnosed with bronchiectasis when i was 17 after 2 years of chronic bronchitis. your symptoms sound identical to mine. it took thousands of dollars of testing to determine that this was what i have. in my case, i had many bronchoscopes and the bacteria in my lungs grew no cultures. my doctors prescribed me broad range cyclic antibiotics as well as xopenex, advair, and mucinex. for a time i was also using a cystic fibrosis vest. i have since stopped taking the antibiotics due to the possible problems that can occur with strains that can become antibiotic resistant.
my pulmonologist said that i got bronchiectasis after getting a staph infection in my lungs after having sinus surgery. i was very sick for two years with a persistent cough. after being diagnosed with chronic brochitis i was hospitalized 2 times in 6 months with pneumonia and double pleurisy. it was only then that they diagnosed me with bronciectasis.
because of the nature of this disease, it takes some time for it to set in. if at all possible, control your symptoms early so that it does not progress to the point of dilating your bronchi and causing irreversable damage.
i know this all sounds scary to those who think they just have a chronic cough. i never thought that i would be a freshman in college doing 4 breathing treatments a day and having bronchoscopes every 6 months. i am now a sophomore in college and i have been able to manage my disease so that i can lead a fairly normal life.
I work with a group of singers with an average age of 78.5. In my latest survey of the group, one of the participants, a 70-yr-aged female who has been part of the group for two years said the following: "my breathing has improved and deepened since starting singing. I never imagined singing in a choir because of a chronic cough caused by bronchiectasis which I have suffered from for 64 years."
I am not a medical doctor, but a person who is aware of the power of singing and many of its positive effects physically, emotionally and psychologically on people.
I have lupus-dx 7 yrs ago. Have any of you thought of asking for some bloodwork to test for lupus or any other type of auto-immune disease? I've been thru or going thru most of things you've posted.
I have been told I have pulmonary fibrosis. I can not get out side without getting sick, I use spriva and advair. Very short of breath. My oxygen level drops when I walk very far. Is there a DANGER when this happens?
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