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  • Pulminary Specialist suggested Silent Reflux

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    Old 03-10-2006, 09:36 PM   #1
    eDeal
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    Pulminary Specialist suggested Silent Reflux

    I have had a cough since November, and I have been spending the last 2 months trying to figure out why it hasn't went away.

    I do not smoke, and I didn't have the cough until a secondary infection hit me after I had the flu. Anyway, the cough has subsided somewhat (it used to come in clusters and make me feel nausous), but comes back randomly, it comes back with a vengeance when I completely empty my lungs.

    I had a chest x-ray and a pulminary function test and both have come back absolutely normal. After the test, it was suggested that I might have "silent reflux". I am not so sure about this though, as I don't ever have signs of indigestion, and cold air seems to make me cough every time.

    I feel nausious on an empty stomach more than a full one, although my appetite has all but disappeared since I had that secondary cold.

    What are signs I should look out for? I have spent way to much time sitting in line for tests and waiting for doctors, and I am at a very busy point in work. The last thing i have time for is another dead end.

     
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    Old 03-11-2006, 09:14 AM   #2
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    Re: Pulminary Specialist suggested Silent Reflux

    Possibly Laryngeal Reflux, known mainly as "LPR" for laryngeal-pharyngeal reflux. Most LPR patients don't get heartburn, indigestion or symtpoms of the most commonly known form of reflux "GERD". The main symptoms of LPR are chronic cough and/or feeling of lump in the throat. Most patients with LPR will exhibit redness and swelling of the larynx, which an ENT can diagnose with a simple in-office scoping of the throat - this does not require any sedation. Treatment for GERD is usually 1 dose of a Proton-Pump Inhibitor (PPI) per day, but treatment for LPR is usually 2 doses of a PPI per day. Prilosec OTC is the only PPI sold over-the-counter without a prescription. All the other PPIs require a prescription, and off the top of my head, I can think of Nexium, Aciphex, Protonix, Prevacid. Nexium is the most "advanced" of these drugs and is the most recent to market. Astrazeneca first brought Prilosec to the market 19 years ago ago, and it was sold as a prescription drug until 2 years ago, when the patent expired. It went over the counter, and AstraZeneca introduced Nexium, which is an isomer of of Prilosec. Most patients with GERD do just fine on any of these drugs, but it appears that the majority of patients with LPR do best on Nexium. I can't explain the mechanism, but with LPR, the acid is rising up out of your esophogous and getting into your throat (so the acid is going even higher than in GERD). Perhaps to counteract that, we need something a little stronger to reduce the acid even more. But I really can't say anything for sure - all I know for certain is that I have tried every PPI except for Aciphex, and nothing worked to eliminate my cough except for 2 doses of Nexium per day. Another poster who has LPR, by the name of "ADGrant", has obtained good relief from Prilosec OTC, so it wouldn't hurt to try the OTC meds. Just don't give up on all PPIs is Prilosec doesn't work.

    One thing you should know about LPR and GERD, is that they are NOT caused by too much acid in the stomach. These conditions are actually diseases, in which the lower and/or upper esophageal spinchter muscles (which are actually areas of pressure), weaken, and fail to prevent the super-strong hydrochloric acid in your stomach from escaping the stomach and going into your esophagous and throat. There are plenty of people with occasional GERD, who have attacks of this problem, but for the most part, the people on this board have permanent problems with these muscles and suffer from GERD and LPR on a daily basis and must be on medication for life. There are surgical options as well, but none are 100% effective, and it seems that most doctors recommend the surgeries only if the medications are not providing adequate relief. My own doctor, who is a heavy-hitter at University of Pennsylvania Medical Center, told me to wait 5-10 years, if I could, before really considering the surgeries. He wants to give them more time to be perfected, and more time for data to come in on them.

     
    Old 03-13-2006, 12:58 AM   #3
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    Re: Pulminary Specialist suggested Silent Reflux

    The next time I go back to the doctor, I will mention this possibility, but a lump in the throat is also something that I have not had a problem with either.

    Thanks for the detailed reply. I still think it is breathing related, since cold air and completely emptying my lungs will set it off. Also, it seems to be related to a "tickle" behind my sternum. But, since every test they have run has come back negative to anything serious, I guess it is just some annoyance I will have to live with.

     
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