Chronic cough

For this topic, I’ll begin with a recent patient encounter:

codeine cough syrup, Tessalon Perles (cough tabs),Singulair, Claritin, Advair, steroids and Azithromycin (antibiotic). His mostrecent appointment was a week ago, where he was treated a second time withsteroids and antibiotics due to the persistent, dry cough occurring in fits. Hedenies sick contacts, shortness of breath, fever, post nasal drainage,wheezing, or night time cough. He’s been skin tested for allergies, with +horsehair and tree allergies. He notes some mild acid taste in throat occasionally.There is no smoke exposure. He never had a swab to confirm Pertussis (whoopingcough infection) and a chest x-ray done in January which was negative”.

His mother and I racked our brainsfor the cause of his never-ending cough. It was now keeping him, a straightA-student, out of school, due to the disruption of his fits of cough. It wasdistracting to him and his classmates and was embarrassing. It was concerningto his mother because nothing worked. She wanted him to see a lung specialist.After various trials of cough medicines, antibiotics, asthma inhalers, andallergy medicines, the cough was non-stop.

Causes of chronic cough generallyinclude the following: side effects from medicines, allergies and mucusproduction, asthma, respiratory infections, and acid reflux. With GERD, orgastro-esophageal reflux disease, there is increased acid production anddecreased acid suppression in the stomach. The acid rises and ascends up theesophagus into the pharynx, or back of the throat, and irritates the vocalcords. Sometimes, it can also cause growths, or cysts, on the vocal cords,which can cause hoarseness out of nowhere, or produce a chronic cough.

For this patient, we’d alreadytreated him for allergies, asthma, and infection multiple times. Afterthinking, I realized his cough probably started out as a whooping coughinfection, but after many rounds of antibiotics and chronic irritation, he waslikely developing some acid reflux on top of it. We tried Zantac twice a day,and his cough quickly stopped. Success! He was still seen with a lungspecialist for follow up, but by then, his cough was gone. I saw his motherlater and she was very pleased the cough was gone, and he could return toschool without embarrassment.

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