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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 50076
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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Ive had a persistant cough since september. Cxr and sputum

Customer Question

Ive had a persistant cough since september. Cxr and sputum samples are negative. Ive noticed everytime i go outside in the air i start petsistsnt coughin. Ive visited gp twice and had coubtkess cough bottles. 02 levels are ok. Help in worn out
Assistant: How long have you been dealing with the cough? Are you having any other symptoms?
Customer: Just general turedness snd not slerping
Assistant: Anything else in your medical history you think the Doctor should know?
Customer: No im otherwise quite healthy. I walk my dog 1 hour each morning and cough continously while.im out.im also bringing up liads of phlegm.
Submitted: 6 months ago.
Category: Medical
Expert:  Dr. Arun Phophalia replied 6 months ago.

The diagnostic and management protocol for the chronic cough is as following;

1) we will do a chest x-ray first; which has been done for you and is normal

2) pulmonary function tests or spirometry is the second step

3) starting of empiric therapy for postnasal drip, asthma, or gastroesophageal reflux. GERD will need further evaluation in the form of esophageal manometry (food pipe pressure study) and pH study of the food pipe (esophagus).

4) methacholine challenge testing to evaluate for airway hyperreactivity; done for the bronchospasm / bronchial asthma.

5) sputum or phlegm examination for eosinophils or empiric trial of corticosteroids for eosinophilic bronchitis.

If despite these measures, cough persists we would consider further investigations like esophagoscopy, 24-hour pH probe monitoring, high-resolution chest CT, or bronchoscopy.

The common causes of chronic cough are postnasal drip (also called upper airway cough syndrome), asthma, and gastroesophageal reflux disease (GERD). These three causes are responsible for up to 90 percent of all cases of chronic cough. Less common causes include infections, medications, and chronic lung diseases. Another common cause of chronic cough is nonasthmatic eosinophilic bronchitis. Following causes should be considered for the cough;

1) Upper airway cough syndrome; they comprise of vasomotor rhinitis; acute nasopharyngitis; and sinusitis. The treatment is by steroid nasal spray or nasal antihistamine. Sinusitis may need antibiotics like trimethoprim-sulfamethoxazole or cefuroxime.

2) Cough variant asthma; this will require bronchodilator medications used in asthma or steroid inhalers.

3) Gastroesophageal reflux disease (GERD); treatment is by avoidance of reflux-inducing foods (fatty foods, chocolate), eating three meals a day without snacking, avoidance of meals for two to three hours before lying down (except for medications), elevation of the head of the bed and an H2 antagonist or a proton pump inhibitor.

4) Postnasal drip; would need antihistamines and inhaled ipratropium bromide.

5) Non-specific cough; Dextromethorphan and/or codeine can be used.

http://www.mayoclinic.com/health/chronic-cough/DS00957

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Customer: replied 6 months ago.
Ive got post nasal drip and have a nasal spray which i use with no effect
Customer: replied 6 months ago.
I prefer to txt as my hearing has also becone very bad for some time and u have a difficulty hearing on phone
Expert:  Dr. Arun Phophalia replied 6 months ago.

A short course of steroids may help you.

You may also need the following investigations for the evaluation;

1) High resolution CT scan of the lungs.

2) Allergy tests.

3) Upper GI endoscopy

4) 24 hours of esophageal pH.

Expert:  Dr. Arun Phophalia replied 6 months ago.

Apologies for any intrusion of those automatic offers for phone calls. These are produced by the website automatically and outside of my control, as mentioned.

Customer: replied 6 months ago.
Ive made a gp apt for 2 weeks and i will show her your reply and ask if any of the tests can b carried out as this cough is becoming extremely worrying and preventing me going into compan6.
Expert:  Dr. Arun Phophalia replied 6 months ago.

Yes, further investigations will help.

Meanwhile, you may try, Ranitidine, and steam inhalation.

Expert:  Dr. Arun Phophalia replied 6 months ago.

Wishing you a speedy resolution and all the very best in life.

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Expert:  Dr. Arun Phophalia replied 6 months ago.

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