Chronic cough - allergies - Allergies Message Board

campark · 04-05-2007, 11:42 AM

I am 41 years old and I have had this chronic cough for probably the last 5-7 years that they can't seem to find out what it wrong. I have been seen by a pulmonologist, ENT, regular Dr. you name it. I was tested for allergies when I was 7 months pregnant, but nothing came up. I am going to be tested again, by an allergist to see is maybe something is wrong. I have had breathing test to determine if I have asthma, they have had me on inhalers, acid reflex medication, they all don't seem to work. I usually cough when I start laughing, after eating, being out in the cold. It usually starts out very tight, almost like I am wheezing then it continues until it gets phelm in my throat. I have coughed up blood only once, but I think it is because I cough so voliently. They have taken x-rays of my lungs and they are clear. Can someone help or does someone have any idea what this might be.
Thanks in advance for your help.
Mindy

MountainReader · 04-06-2007, 12:08 AM

Campark,
I have had a problem with a chronic cough since December 2001. Some of my main triggers are: bad air, cold air, chemical smells, allergens, laughing, some foods, sinus infections. It took me years to find something that helps keep it in check.

The way my doctor described it, there are four main causes of chronic cough:

allergies
asthma
post nasal drip
acid reflux

It sounds like your doctors are treating all of these so you are on the right track. For me, I have discovered I have all four--and my primary symptom is often just a chronic cough for all but the allergies. It has taken years to find the right balance of treatment to keep all under control at the same time. I find when one gets out of whack, it often throws another off too.

Here is what worked for me:

allergies and PND= Allegra, Flonase, Astelin, immunotherapy (although that really only helped on one of my allergies)
asthma= Albuterol, Advair 500/50 (this was increased over 3 years), Singulair
Acid Reflux= Prevacid TWO times per day (one dose of PPI's per day never helped) (Look on the acid reflux board under LPR for more information)
Diet modifications also helped a bit.

I still have some problems when there are winter inversions with bad air quality, but otherwise, this combination has increased my quality of life tremendously.

I hope this helps some.

Good Luck finding what works for you.

Reader

aswander · 04-10-2007, 11:44 AM

I'm betting that acid reflux is the main culprit. If it is, you need to be treated with Proton Pump Inhibitors (PPIs). These pills reduce the amount of acid your stomach produces, thereby limiting the amount of acid that can escape your stomach and esophogous. See, stomach acid is called hydrochloric acid, and it has a pH of 2 - that is crazy acidic. Your stomach can handle it, but your esophogous and throat have no natural protections against it. And yes, that acid can somehow defy gravity and go north into and out of your esophogous.

You probably want to do some searches and familiarize yourself with the following terms: The Cough-Variant of acid reflux disease is called "Laryngopharyngeal Reflux" or LPR. Sometimes it is referrered to as "Laryngeal Pharyngeal Reflux" or atypical reflux.

To treat LPR, you need 2 doses a day of a Proton Pump Inhibitor. Your primary care can prescribe it, but it's a good idea to head to an ENT and get yourself scoped. He'll look at your larynx and see if it's all red and swollen and damaged.

If the PPIs don't work, you'll probably need to see a gastroenterologist and have some more tests done.

There are 5 or 6 brands of PPIs. LPR is harder to treat than the GERD-variant of acid reflux, so as I said you need a double dose. But brand is important. Simply but, Nexium and Aciphex are the gold standards.

In my opinion, I'll rank them in order of effectivenss:

1. Nexium
2. Aciphex
3. Prevacid
4. Zegrid
5. PRilosec (Brand name) by prescription only
6. Protonix
7. Prilosec OTC

Prilosec OTC doesn't work for LPR at all. I've never communicated with an LPR patient who was successfully treated with the OTC stuff.

Get a script for Nexium, 40 mg 2 x a day (2 x a day on a prescription is written "BID"), so you'll be taking a total of 80 mg a day. Take the pills together first thing in the morning.

While you're recovering, please stay away from coffee, caffeine, alcohol, and anything that you do that crunches your stomach like sit ups.

And visit the acid reflux message board!

campark · 04-13-2007, 07:37 AM

MountainReader and Aswander,
Thanks for your answers. I have been to the ENT and he did a cat scan of my sinus's but not a scope. Do I have to request one? Also is a cough a primary syptom of LPR? Thanks so much for responding and helping me figure this out.
CamPark

aswander · 04-13-2007, 05:00 PM

People who have LPR typically have 1 or more of these primary symptoms:
-chronic cough
-chronic throat clearing
-sensation of "lump" in the throat
-difficulty swallowing
-hoarseness

Everyone has her own combination of symptoms. Most ENTs aren't familar with the full extent of problems LPR can cause, so your ENT may not be the one to go to, especially if he hasn't done a scope yet. You may need a "heavy-hitter" in the local big city or affiliated with a university teaching hospital.

One thing to note - the absence of a red and swollen Larynx does not mean that it isn't LPR, and the presence of redness and swelling does not necessarily mean LPR, however, in most cases, the redness and swelling is a good indicator of LPR.

Also, some people need to take the PPIs for life, others are able to get off after 6 months. Sometimes you need to be on for a few years. It's a strange condition.

Once I developed hoarseness, I discovered that using the corticosteroid "flonase" helped a lot as well, just as mountainreader suggested - I think she mentioned a competing brand - it's all the same. But it did help.