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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18785
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I have had a severe cough 3 months. This comes in

Resolved Question:

I have had a severe cough for over 3 months. This comes in prolonged spasms which leave me exhausted and sometimes I seem to lose control of my body due to the severity of the coughing fit. I cough up a large amount of white sticky phlegm. I have had antibiotics, steroids and steroid inhalers over the past 3 months but to no avail. I have been taking Lanzoprazole 2 per day 30mg for a number of years.
How can I reduce the amount of white phlegm being produced? Can I get the phlegm tested to see what is causing it?.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
Hello from JustAnswer.
It will help if you could provide some further information.
What evaluation has been done thus far to identify the cause of the coughing?
Are you taking any chronic medicines for any other medical problems?
Customer: replied 1 year ago.
Chest X ray and scan - both clear.
Lung Function test - goodI take epilim tablets, 2 per day for epilepsy and 1 colestrol tablet daily
Expert:  Dr. D. Love replied 1 year ago.
Thank you for the additional information.
Effective treatment of a chronic cough or reduction of the associated phlegm would require identification of the underlying cause.
There are several other tests that may be helpful in determining the cause of the symptoms. Yes, an examination of the phlegm/sputum can help to identify certain underlying causes, particularly infectious diseases. The acute respiratory infections are usually better detected with a chest x-ray, but certain chronic infections, such as tuberculosis or fungal infections of the lungs are harder to identify and microscopic examination and culture of the phlegm may be helpful.
Sputum that is obtained by a cough is sometimes difficult to analyze well, because the sputum can acquire the normal germs in the mouth and throat. It also may be necessary to consider a bronchoscopy, both to consider the possible diagnoses that may cause the cough, but also can collect a better specimen of the phlegm.
It also would be appropriate to perform further evaluation of the sinuses and upper airways. A CT scan of the sinuses may be helpful. Another option would be consultation with an ENT specialist, who can perform a better examination of the nose and sinuses.
Acid reflux is another common cause of a persistent cough, and the lansoprazole will usually control the acid reflux. However, with persistent cough, there should be some consideration of whether there is acid reflux that is not responding to the lanoprazole. An endoscopy or a 24 hour esophageal pH probe can assess whether there is stubborn acid reflux.
It is not common for us to need to do a scope of the lungs, sinuses, or esophagus for cough, but in someone with persistent severe symptoms, it may be necessary to do so.
It would be appropriate to perform testing of the sputum and imaging of the sinuses first, since these are non-invasive tests, but the other evaluation may also be necessary.
If I can provide any further information, please let me know.
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