Chronic Cough Workup, Part III
Eosinophilic bronchitis (EB) is an airway inflammation affecting all sizes of airways, which causes a chronic cough, but no wheezing. It is distinguished from asthma and cough variant asthma by normal spirometry tests (always) and a negative inhalation challenge test , although sputum tests and eNO demonstrate an eosinophilic airway inflammation. Cough reflex sensitivity is normal in patients with EB.
Inhaled corticosteroids effectively suppress the superficial airway inflammation of EB, but unlike typical asthma, bronchodilators such as Albuterol are not helpful (because such patients have no bronchoconstriction). About 20% of patients with EB develop asthma over the years, but this risk may be reduced by inhaled corticosteroid therapy. In others, the EB just resolves by itself.
Atopic cough is a category recently proposed by Japanese investigators. It has all the features of EB except that cough reflex sensitivity (CRS) is abnormally high and antihistamine therapy is usually successful (as with allergic rhinitis), but there is no evidence of allergic rhinitis (hayfever).
Sino-bronchial syndrome (SBS) is a new name for rhinitis causing sinusitis which causes post-nasal drainage (PND) which leads to chronic throat-clearing and cough. Sinusitis can be confirmed by a sinus CT scan, but PND and sinusitis symptoms are usually enough evidence to confirm sinusitis. Many such patients have allergies which affect their nose, but no lower airway inflammation (thus spirometry, MCT, and sputum eosinophil levels are normal). The cough reflex is usually normal. The usual sinusitis treatments are usually beneficial, and chronic erythromycin therapy usually eliminates the chronic cough.
GERD (gastro-esophageal reflux disease) can cause a chronic cough and is increasingly common as people gain weight, but also occurs in thin people and may not cause the classic symptom of heartburn after eating a heavy or spicy meal. The gold standard test for GERD uses a 24 hour esophageal pH probe, but this is expensive and poorly accepted by many patients, so GERD is usually ruled out as the cause of a chronic cough by a 3-6 month trial of a proton pump inhibitor pill (PPI, which eliminates gastric acid production).
Chronic idiopathic cough (CIC) is a category proposed by British investigators in 2005. Idiopathic means that all other causes of a chronic cough have been ruled out, so doctors don't know what's causing it. Such patients have an increased cough reflex sensitivity, as measured by inhalation of increasing concentrations of capsaicin. None of the other tests mentioned above are abnormal. Capsaicin is the "spice" or heat from chili peppers and the principal ingredient of Mace, but the CRS test uses low concentrations and is very safe and well-tolerated by patients. The onset of the chronic cough of CIC is often with a upper respiratory viral infection (URI), but the post viral URI cough of most people resolves within a few days or weeks. Interestingly, the only abnormal test of those with multiple chemical sensitivity is also cough reflex sensitivity.
Chronic Cough Workup, Part I
Chronic Cough Workup, Part II
Related Topics: Asthma Complexities, Coughs: Home Remedies
Inhaled corticosteroids effectively suppress the superficial airway inflammation of EB, but unlike typical asthma, bronchodilators such as Albuterol are not helpful (because such patients have no bronchoconstriction). About 20% of patients with EB develop asthma over the years, but this risk may be reduced by inhaled corticosteroid therapy. In others, the EB just resolves by itself.
Atopic cough is a category recently proposed by Japanese investigators. It has all the features of EB except that cough reflex sensitivity (CRS) is abnormally high and antihistamine therapy is usually successful (as with allergic rhinitis), but there is no evidence of allergic rhinitis (hayfever).
Sino-bronchial syndrome (SBS) is a new name for rhinitis causing sinusitis which causes post-nasal drainage (PND) which leads to chronic throat-clearing and cough. Sinusitis can be confirmed by a sinus CT scan, but PND and sinusitis symptoms are usually enough evidence to confirm sinusitis. Many such patients have allergies which affect their nose, but no lower airway inflammation (thus spirometry, MCT, and sputum eosinophil levels are normal). The cough reflex is usually normal. The usual sinusitis treatments are usually beneficial, and chronic erythromycin therapy usually eliminates the chronic cough.
GERD (gastro-esophageal reflux disease) can cause a chronic cough and is increasingly common as people gain weight, but also occurs in thin people and may not cause the classic symptom of heartburn after eating a heavy or spicy meal. The gold standard test for GERD uses a 24 hour esophageal pH probe, but this is expensive and poorly accepted by many patients, so GERD is usually ruled out as the cause of a chronic cough by a 3-6 month trial of a proton pump inhibitor pill (PPI, which eliminates gastric acid production).
Chronic idiopathic cough (CIC) is a category proposed by British investigators in 2005. Idiopathic means that all other causes of a chronic cough have been ruled out, so doctors don't know what's causing it. Such patients have an increased cough reflex sensitivity, as measured by inhalation of increasing concentrations of capsaicin. None of the other tests mentioned above are abnormal. Capsaicin is the "spice" or heat from chili peppers and the principal ingredient of Mace, but the CRS test uses low concentrations and is very safe and well-tolerated by patients. The onset of the chronic cough of CIC is often with a upper respiratory viral infection (URI), but the post viral URI cough of most people resolves within a few days or weeks. Interestingly, the only abnormal test of those with multiple chemical sensitivity is also cough reflex sensitivity.
Chronic Cough Workup, Part I
Chronic Cough Workup, Part II
Related Topics: Asthma Complexities, Coughs: Home Remedies
Technorati Tags:
27 Comments:
"chronic erythromycin therapy usually eliminates the chronic cough."
Why is erythromycin the antimicrobial of choice? Is there a specific bacteria that they believe cause this, or is erythromycin broad spectrum enough to treat most of the likely culprits?
Just curious.
I have a son wich is only 3yrs old I want to know how can I treat his asthma and that chronic cough. he takes pulmicort
last year i had a post-URI cough that lasted a few weeks. my (excellent) doc prescribed me an inhaled steroid (advair diskus) which seemed to ease the cough away.
now i am in the same boat again, but only two weeks out. any danger in starting the steroid too early post URI?
To OWL: It is my understanding that many antibiotics (including emycin and zithromax) may help the lungs by a direct effect on improving mucociliary clearance, even in the absence of a bacterial infection.
My sister has had a cough since July 2006. She 's been diagnosed with pnuemonia twice, seen an ENT,allergist, infectious disease doctor, PCP and a pulmonologist. She has a low IGg level, ct. scan showed thickening on one lung and resolution of another. She's been on antibiotics and steroid. Still coughing any advice?
I cough after eating. I only cough once, but it happens after almost every big meal. Is this a sign of a digestive system issue? Any help/advice is greatly appreciated.
I have had a chronic cough since 2006. It's like I'm choking. My throat is sensative. I cough when I eat,when I brush my teeth,when I use my voice or it happens any time of day or night. I use tussionex. If it was'nt for this medicine I couldn't function. My vocalcords feel irratated and my voice cracks. Sometimes I strain so hard when I'm coughing I throw up. Can anyone out there please help me. miserable
Just like R's mom, I have been coughing for at about three years with the same symptoms. Coughing when I try to sing, when I talk a lot, sometimes just when I swallow I'll choke and start coughing. Sometimes my throat gets very irritated, other times just a little. People think I have the flu all the time. I've taken meds for post nasal drip,asthma,allergies and acid reflux over the years. Nothing has worked and I'm still coughing, year round. No time of the year is better or worse. I'm miserable and the drs. just don't know anymore.
I have also had a cough for a little over 2 years. I am about at the end of my rope with it. I have been to the Pulmonary Specialist, Allergist, ENT Specialist. No one can give me a reason. I also have all of the problems with constant coughing when I talk, sleep, eat, sometimes so bad I throw up. My daughter is getting married August 2nd and I am so afraid I am going to ruin her wedding by coughing thru the ceremony. Any advice from anyone is greatly appreciated. I dont know where to go with this. My doctor says I just might have to live with it. Thats not good enough for me.
Here is a puzzeling challenge. I have had a cough for about 10 years and it gets worse as I get older. When my stomach gurgels I cough or when I am very hungry. I just can't stop coughing, so I drink water(temproary fix). I have seen a Pulmonary doctor as well as as a stomach doctor. I was having one of my cough attacks during a CT scan (real bad attack I wanted to puke) and it came back clear so obviously it is not my lungs.
My grandmother has had a chronic cough for years. Now, my aunt who lives with her is starting to cough just as bad. Does anyone else have people in their same household with chronic cough too? I'm wondering if maybe they have something contaminating their home now because of their coughing- mold, asbestos, etc. Any thoughts?
to Allison-
My father has had a cough for a few years. After his wife passed away I moved in to help take care of him. In the 3 years I have resided, I have also gained this cough. I know it is something in the house. I just don't know what. My cough is now all day and night, often throwing up, and my throat feels constricted all the time. I have placed a small 8 inch fan at my computer desk, approx 1 foot away, blowing on the side of my face. I find it helps keep the coughing at bay. Obviously there is nothing I can do about it while sleeping or away from my desk.
i have had a "cronic cough" for over two years. i have been to a pulmonary dr. my general dr. as well as an allergist. i have been on inhalers, cough meds, meds for asthma. i have had a chest x-ray, a full pulmonary funtion test and passed. all the doctors state that is is not asthma. in the mean time i am taking an anhistamine. that helps a bit. i also always have cough drops on hand and water. that keeps the cronic cough at bay a bit. i also irrigate out my sinusis with the nepi pot. doe s anyone have any suggestions what else i can try ?? the constant coughing is very mentally and physically draining..
christine :(
I can't believe how many of us are out here "coughing our guts out" with no help from the medical community. My symptoms are the same as many: any time, no triggers, cough until I nearly faint sometimes. Embarrassing, irritating, and lift changing. When one is driving, it can even be dangerous to others! With all the medical "experts" in our country, why is the cough such a problem?
I'm only 24 years old and my cough has taken over my life. I can't sleep well, it makes me throw up and I can barely play with my son without having an episode. I've been to so many doctors and specialists but so far no luck...... We have to do something
Seriously...we are all suffering from some sort of multiple chemical sensativity. We are bombarded day after day w/cleaners and perfumes and heavy saturating scents that have overwhelmed our systems and our bodies can't take it anymore!! I'm reading all of these comments and I suffer from the same things, due to facial surgery and or a facial blow I too suffer from a chronic cough and it comes on after a heavy scent has crossed my path. Make the doctors sit up and take notice that we exist and need help!!
I have a 7 yr. old daughter who has had a chronic dry cough for about a year now. We've been through doctors, allergists, and now even chiropractor(sounds weird I know) but nothing seems to help we've been through sinus/allergy meds and inhalers and cough meds nothing works. No one can seem to figure out what it is. any suggestions???
Hello, I also have a dry cough that I feel is getting worse and don't know what to do. I suck on cough drops all the time and also through the night. I was hoping one of you would have a suggestion. Thank you. Sharon
Karen
I have been treated for over a year with several antihistmines to no avail. I do not smoke and I never have. I work in the healthcare setting and now I have been told that I have staph. What should I do??? The cough and mucus have been present for over a year.
Thanks!
I have had a chronic cough for approximately one month. I have been on two rounds of antibiotics. This seems to help for about one week. I have also been on prednisone and several different inhalers. I use a nebulizer 4x a day. All thias helps for about 30-45 minutes. Then I am coughing again. I cough til I feel like I am going to pass out. I've had chest x-rays ad sinus x-rays. I take an antihistamine daily along with cingular and symbicort. I cannot even laugh with my kids without having an episode.
I was beginning to think I was crazy, it's such a relief to hear other people explaining the same exact symptoms. I even tried sinus surgery 5yrs ago to widen my passages, that didn't even cure my cough. I'm driving everyone nuts with my constant cough. I feel like I run from doctor to doctor because I'm so desparate!
To Alison, yes dear if you are in a household with a mold spore and or dust, pollen and other irritants like smoke,others in the household will cough too.I can tell if my asthmatic bronchitis is caused by an enviornmental issue because my landlord also has attacks.I use Albuterol and Advair,with little success with the coughing but it does help breathing.
Unfortunately the only thing that helps me during long attacks is using opiates,like codiene.Too bad they're addictive.
I just visited a web site that advocated using a Nebulizer with Colloidal Silver to wipe out Bronchitis in a few days.It sounded interesting ,but I doubt that insurance plans would cover it.
Try to clean up your enviornment.And you can try an air purifier.Th ozone generating kind can irritate you more so air out the house after ozonating to kill mold or dust mites.I am not saying you have a dirty house ,but I do and it is a sick building too lots of mold. Good luck. Coughing in Ct.
My husband has a chronic cough that has now been going on for several years and the last 6 months has only gotton worse. They said he doesnt have any kind of asthma so they gave him medicine for gerd ven though he doesnt have heart burn at all. The meds actuall seemed to have made the cough worse. He cant eat without coughing and it lasts for literaly hours. Its so loud I can hear him a block away. I can sleep even with ear plugs. They are still trying to figure out what is causing it but so far no luck. Could they be missing something. I have neve heard a cough so harsh and LOUD. We need help
Darlene
I used to cough for about an hour after I laughed a lot and used to get a lot of bronchial type colds until I got really sick to where I couldn't talk or breathe. That was 15 years ago and was told I had asthma. I've read where asthma causes the bronchial tubes to become inflammed and produce more mucus. About 6 months ago I got a really bad cold and have been coughing since then. Tried a different blood pressure med since some cause coughing. Tried the GERD medicine to see if it was any type of acid reflux. Got sent to an allergist/asthma doc and he did the methacoline challenge test and it showed I didn't have asthma. (After 15 years of taking inhalers!) He believes I have irritant induced vocal chord dysfunction which masks itself as asthma and causes the chords to swell making it difficult to breathe and causes the hoarse/raspy voice I get when exposed to irritants, allergies or stressful situations. They are doing more tests to check my vocal chords. He told me I'm a complex case. I just want to stop coughing. Codeine in the cough syrup helps at night (when it is worse) but can't stay on that forever.
my grandson is five years old and has had a bronchial cough for a year now. Every time he goes back to the dr they say it's something else. They haven't checked for allergies - this little boy suffers during the nite and it's heartbreaking because I can't seem to get him the help he needs. Any suggestions? I live in FL (doowopdreamin@yahoo)
Has anyone discuss there symptoms with a Tourettes specialist? I have been coughing since 1998 (that I remember) and I believe it may be related to a "nervous tic".
I definitely notice I start to cough with changes in room temperature, drinking fluids, caffiene, which made me think it was lung related...
After many years, I realized that I would often cough to feel the sensation of coughing. This is kind of like trying to achieve the sensation after yawning (also another common tic). I noticed that my coughing gets much worse when I have stress at work or home.
More importantly, I noticed something very intersting that leads me to believe it is partly psychosomatic. If my wife hugs me, I almost immediately stop coughing. Maybe there is a stress reduction that occurs with this hug? "nevous tics" are exacerbated by stress according to the research I have done.
Could this be partly biological caused by irritants in the lungs and the related constriction of mild asthma PLUS a psychosomatic component that perpetuates the cough endlessly?
Reading all your comments has just made me feel more depressed about my chronic cough. I've had this cough for about 10 years -- I cough when I get up; when I eat; when I breath a strong odor; when I talk. I've seen an eye/ear/throat specialist; pulmonary specialist; and an allergist. I cough so hard I actually passed out once and frequently worry about coughing while I'm driving. I've also thrown up my food. I currently take Nexium for GERD and I've used inhalers, etc...nothing seems to work. Even my doctor has said he's given up!! I hate to go out to eat because it is so embarrassing to cough every time I eat. I've tried an elimination diet -- this worked to a point, but I am "sensitive" to so many foods, I'd be cutting out whole food groups and eating only turkey and pears!
I wish someone could help me. The constant coughing is exhausting and irritating to my husband.
I am in the same boat as a lot of you with a chronic; however, I don't have it all the time just 3-4 months per year. Last year it didn't appear at all, yaaaa! However, every time I get it, I feel like I'm treated like a person with a dangerous catchy disease! I am not contagious, but everyone thinks I am. After 6 weeks of coughing now (it came early this year-fall), people are starting to yell at me to go to the doctor and get some help. They don't seem to understand that nothing much can be done. I don't even know what triggers mine; however, at the moment, I can't be in air conditioning too long or in front of a fan as that makes the cough worse.
Post a Comment