DEAR DR. GOTT: I am a 19-year-old female and have had a nonproductive cough for 16 months without any other symptoms other than some slight drainage down the back of my throat. I have kept food and cough diaries and cannot find anything that triggers it. I cough when I sit, stand, laugh, after strenuous exercise and around smoke; it seems that I cough all the time.
I have seen my family physician, a nurse practitioner, an ENT, his PA, a pulmonologist and his PA. I have been diagnosed with bronchitis, hiatal hernia, asthma and heartburn. None of the medication given for these diagnoses has worked. I’ve been on Symbicort, Spiriva, codeine, Prilosec, Zantac and one other that I can’t remember the name of. I had to take it for five days for what they thought was bronchitis. I had a chest X-ray done in July 2009 without abnormalities. There is nothing wrong with my vocal chords, either.
At my last visit to the pulmonologist, I was told that I have irritated bronchitis and that I would have it for the rest of my life unless it miraculously went away. There is no treatment for it. I cannot accept this diagnosis. This cough is truly annoying. I work at an elementary school and am currently attending nursing school. Coughing all the time makes people believe that I am sick, and nobody wants a nurse who is coughing constantly in a hospital. I am sure that you can understand my predicament. I am out of options. I don’t know what else to do or who else to see.
Within the past two weeks, I have noticed that I have all of a sudden been getting heartburn. No acid comes up in my throat, and it usually never lasts for more than a few seconds, but it is a new symptom. Doctors have asked me in the past if I have had heartburn, but I never have up until now. Please help me, Dr. Gott.
DEAR READER: Chronic cough can have many causes; most are benign. Up to 90 percent of all cases are caused by postnasal drip, acid reflux or asthma.
Postnasal drip is a common condition in which the sinuses drain down the back of the throat rather than from the nostrils. This can be associated with colds, the flu and various allergies. I suggest that you take a look at your environment to determine if there is something that may be causing this. Did you get a new pet or move? Did you start wearing a new perfume or using a new scented soap or shampoo? Did you begin using a new laundry detergent or fabric softener?
You may want to talk to your physician about a trial course of an allergy medication. Over-the-counter options include Claritin, Zyrtec, Benadryl and various store brands with the same active ingredients. Prescription options include Nasonex, Flonase, Clarinex and more. These should dry up the drip and, if it is the cause, the cough as well.
I am hesitant to believe that you have acid reflux or asthma because treatment failed to improve your cough; however, they may still be the culprits. Acid reflux can be helped through changes in diet as well as physical activity. Limit your intake of fatty, greasy foods, high-acid foods and spicy foods. You may not have typical symptoms. Asthma may require daily preventive therapy such as a steroid inhaler in addition to a rescue inhaler for emergencies.
Your new symptom of heartburn may be related to acid reflux, but it may also simply be the result of your constant coughing.
Other possible, yet unlikely, causes include infection, lung disorders or cancers, and various medications. I urge you to undergo another chest X-ray, since it has been more than a year since your last. Your pulmonologist can then compare the two films side by side to determine whether there are changes that might indicate a more insidious cause.
If you are uncomfortable with your current physicians and their assistants, start fresh with another lung specialist or primary-care physician. Express your concerns about the cough, and be sure to bring all your medical records with you. The new physician can offer a new perspective and insight into your situation and may find something that the others missed.
To provide related information, I am sending you a copy of my Health Report “Pulmonary Disease.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
About Dr. Gott