I can't stop coughing!

April 28, 2009 10:41 PM

Chronic cough has bothered me for two years. Five doctors have been unable to help me. I am at my wit's end. Help!

As I write this I am suffering from a coughing bout that has kept me up two hours past my bed time.

I developed chronic cough sometime around when I started working in the summer of 2007. I am a healthy white male in his twenties. I feel like I have always tended to cough a little, but it was around that time that things got really bad. Over the course of these two years I have been to five doctors: my childhood pediatrician, two internists, an asthma/allergy specialist, and a pulmonary specialist.

I saw the pediatrician around a year and a half ago. She did not know what I had. She gave me antibiotics (clarithromycin perhaps), nasonex, and advair. These did not seem to help.

My allergist did two lung tests which he thought confirmed I did not have asthma. I was also subjected to a battery of 20+ allergens. I was allergic to 75% or so. But this was during the winter and during that time I was still suffering from my cough, and because of this the doctor did not think it was allergy induced. As a diagnosis by exclusion he thought perhaps I had acid reflux and recommended nexium. This I took on and off but got the flu during that time and so was very bad about taking my meds. I was highly skeptical of his diagnosis, although I admit that after very spicy foods I do cough (but to be fair I also notice my sinuses running heavily). But I also notice that I cough after eating especially bland foods sometimes. It's really hit or miss though.

Things started getting REALLY bad about four months ago. This motivated me to get a physical. I passed this physical with flying colors. I was tested for TB at that time. My doctor also did blood work to test for walking pneumonia, which I had in high school. The test came back negative and noted that I had the antigens. No surprise there. The doctor suggested I take a CAT scan and reiterated it might be possible that I could have acid reflux. The CAT scan came back negative. A "cookie swallow" was suggested for in the future. He noted that when he listened to my lungs as I sang AAAAAA, one chamber sounded as though I was saying EEEEEE, which he thought could be indicative.

The pulmonary specialist agreed that he did not think I had acid reflux. He observed that my throat was highly irritated and that I seemed to have nasal trip, most likely due to allergies. He thought that because I have been coughing for so long that my cough reflex was worn to the point where anything and everything made me cough. He recommended a full assault. He prescribed me prednisolone, clarinex, singulair, and codeine cough syrup, and recommended nasal irrigation.

This regimen brought my cough to a more manageable level but I still experience bad symptoms. Things will especially flair up when I am trying to go to bed and when I am working out. For the latter the pulmonary doctor prescribed an albuterol inhaler; it flat out does not work. And I can be sitting in my chair beside my bed not coughing but after I do my routine and get into bed I will start feeling like my lungs are wheezing and begin coughing. Anxiety plays a role I think.

I am getting to my wit's end. I feel like my doctor's are blowing me off, but I know of course that they have other patients with life threatening illnesses and that a case of chronic cough, which is so difficult to diagnose, ranks low on their list of priorities. Suggestions?

posted by prunes to health & fitness (21 comments total)

Vasomotor rhinitis with post nasal drip triggering a cough?

Drove me nuts for 6 months until my new doctor diagnosed it right off the bat without even looking at my throat (she did after, to make sure). Treatment was two nasal sprays for a couple of months (one steroid and one decongestant) and fixed me right up.
posted by fshgrl at 11:01 PM on April 28

Is your cough dry, or productive (mucusy)? That might make a difference for people trying to help armchair diagnose you.

I do some work that requires me to be recorded, and when listening back to a tape one day I noticed how much I coughed before we started, compared to anyone else I work with. I think I was coughing out of nervousness- like I wanted to "be ready" to record so I was coughing to make myself ready-- basically fidgeting, but with my voice. The urge to cough felt real, but then I'd notice that I didn't actually cough any more after leaving the booth. My coughs were only slightly productive- not dry barking coughs, but no real phlegm would move, either, which was also kind of a tip-off that I didn't really need to be coughing. It was almost like soft OCD- a mental/physical urge to cough, unrelated to debris in my lungs or windpipe. But filling up audiotape with my coughing week after week kind of made me sound unsuitable for the job.

Basically I tried to consciously make myself stop: my rule is, when I'm not sick or choking, I don't allow myself to cough unless I count to 5 and I still want to after that. Usually I find that the urge goes away, because it was a mental urge to begin with.

Also, I replaced the urge to cough to some extent with licorice pastilles- there's a brand called Meloids and the unfortunately named Nigroids. Both were recommended to me by singing teachers. They're tiny, hard, not-very-sweet dots of black licorice, and they kind of lubricate your throat- I find them really helpful. They're only around $4 a container, so worth a try maybe. Oh, and if the licorice taste is too much, you could also try Valda (in the $7 range)- they're gummy eucalyptus/menthol pastilles used by opera singers.

Since I've started the combination of deliberately delaying my coughs and sucking Meloids when I have to do recordings, I've noticed that my cough frequency has decreased a lot. Good luck!
posted by pseudostrabismus at 11:01 PM on April 28

It's a dry cough, but I its not some *eh**eh* type of a thing. It's more of a whooping cough, as though I am clearing my throat but trying to dislodge something down in my lungs. I never cough up phlegm though.

Right now I think I'm coughing because I aggravated it somehow. Advice would be appreciated so that I can go to bed.

fshgrl, my pulmonary doc thought it was allergic rhinitis, but vasomotor seems like a good idea to suggest.
posted by prunes at 11:13 PM on April 28

Have you tried Tessalon (benzonatate)?
posted by scody at 11:27 PM on April 28

Don't rule out allergenic rhinitis. I had a cough from allergenic rhinitis for months and didn't know it because I only coughed when sleeping. Postnasal drip was the culprit. From what you said earlier, it doesn't sound like you were able to get a definitive answer on the allergy tests. If you do have allergies, it's to your benefit to find out ASAP.

You should never feel like your doctor is giving you the brush off. If you do feel like you're not being taken seriously, it might be time to change doctors. Two years is a long time to suffer. Get well soon.
posted by LuckySeven~ at 11:52 PM on April 28

Yeah my doc said that they often get mixed up and the default is usually allergies. In my case allergy medicine just made me sleepy. And the steroid inhaler made me wired. So that was fun.

Have you tired a hot honey and lemon drink with a few cloves floating in it to soothe your throat and then trying to fall asleep with your head propped up a bit to ease your breathing?*

*TM my Mom.
posted by fshgrl at 12:58 AM on April 29

It's funny seeing your post because I've been having trouble with coughing lately too. I found what was causing it from an online group I belong too. Someone mentioned that often when somebody thinks they're allergic to a cat, it's not the cat but the dust/scent from the cat litter. We'd just bought some Tidy Cat and they've reformulated it. It's got a baby powder scent that has real staying power.
I sounded like I'd been smoking 3 or 4 packs for 20 years but it got better as I coughed the stuff out of my lungs as the day went on. Keeping my cat at the end of the bed and giving my blankets 5 minutes or so in the dryer has helped immensely. That and also buying some unscented litter.
I have allergies and they can flare up when I'm in bed. If you sleep on your side, your face is inches away from your pillow which can have dust mites or get a little musty from damp hair setting off allergies. My solution is to cook my pillow in the dryer for 30 minutes on the hottest setting. That kills pretty much everything. This might not be your problem but it's not much effort to rule out and an easy fix if it is. Hope you figure out the cause what ever it is soon!
posted by stray thoughts at 1:11 AM on April 29

I used to say I got a cough twice a year and it lasted 6 months each time.

Did the same bullshit battery of tests you did, plus a bunch more over a decade. Took OTC meds, prescription meds (including nearly incapacitating codeine), ad nauseum. I had diagnoses from athsma to Legionaire's disease, mycoplasm, allergy, psychological, you name it. (It was enlightening to see the professional medics puzzle their way around it, and it showed me how their reasoning skills are no better than mine.... something I preach routinely now.)

What did work fairly well for me was the active ingredient in Nytol (Diphenhydramine Hydrochloride), but that came with a dose of fatigue, so it wasn't practical.

I noticed that when I visited Vermont from my normal digs (Asheville, NC), it subsided. The major difference is clean air. REALLY CLEAN AIR versus damned dirty air with lots of particulates, NOX and SOX, and Flying Spaghetti Monster knows what else. It is one reason I am currently IN Vermont... I like to breathe and we have the cleanest air you can get that isn't in a steel cylinder. Now, I run marathons. My tendency to cough is somewhat positional, as in I cannot lie on my left side without coughing, suggesting something in my upper respiratory/nasal sections is a bit hyperactive and mechanically influenced, but for the most part, the cough is gone.

Check the air quality where you live. Do not rule out environmental causes. You may be a 'mine canary' telling everyone around you that there is danger in the air.
posted by FauxScot at 1:30 AM on April 29

It's a dry cough, but I its not some *eh**eh* type of a thing. It's more of a whooping cough, as though I am clearing my throat but trying to dislodge something down in my lungs. I never cough up phlegm though.

Did you ever try taking the acid reflux medication properly, like religiously for several months with no skipping? And have you had a barium meal to rule out reflux? Because I have a combination of low level but constant allergies (with occasional post nasal drip) and acid reflux and this describes me to the point it's eerie. The rest fits too, worse when I go to bed and definitely worse during/after exercise. Even a small amount of reflux that you don't otherwise feel can end up in a cough because you aspirate really fine droplets of acid which in turn causes bronchitis.

For me the only way I got on top of it was by taking both my stomach medication and antihistamines really really carefully, avoiding all my known food triggers, and started using a steroid nasal spray (Flixonase), again totally religiously, no skipping, like ever. It took about four months for my throat to heal and the coughing to subside and I still cough occasionally if I don't eat regularly enough. I just didn't see the part in your post where you really gave the acid reflux medication a good solid shot, and skipping a dose here or there really does make a difference. It's likely that the allergies are contributing and they can definitely make an otherwise minor amount of refluxing turn into this problem.
posted by shelleycat at 3:32 AM on April 29

Have you seriously never been prescribed DXM before? Get hold of some (pure) by whatever means and take it when needed (sleep, exercise, whatever). This will at least give you some quality of life back while the doctors can work out a better solution.
posted by turkeyphant at 3:38 AM on April 29

Have you seriously never been prescribed DXM before? Get hold of some (pure) by whatever means and take it when needed (sleep, exercise, whatever). This will at least give you some quality of life back while the doctors can work out a better solution.

I take Nyquil to fall asleep fairly often. That's a good idea. Doctors still give out pure DXM prescriptions?
posted by prunes at 5:02 AM on April 29

Did you ever try taking the acid reflux medication properly, like religiously for several months with no skipping? And have you had a barium meal to rule out reflux? Because I have a combination of low level but constant allergies (with occasional post nasal drip) and acid reflux and this describes me to the point it's eerie. The rest fits too, worse when I go to bed and definitely worse during/after exercise. Even a small amount of reflux that you don't otherwise feel can end up in a cough because you aspirate really fine droplets of acid which in turn causes bronchitis.

For me the only way I got on top of it was by taking both my stomach medication and antihistamines really really carefully, avoiding all my known food triggers, and started using a steroid nasal spray (Flixonase), again totally religiously, no skipping, like ever. It took about four months for my throat to heal and the coughing to subside and I still cough occasionally if I don't eat regularly enough. I just didn't see the part in your post where you really gave the acid reflux medication a good solid shot, and skipping a dose here or there really does make a difference. It's likely that the allergies are contributing and they can definitely make an otherwise minor amount of refluxing turn into this problem.

After getting my CAT back perfect I decided to hold off doing the barium test and instead try Prilosec OTC. I was finishing up a 14 day cycle of Prilosec when I had my pulmonary doc visit. I hadn't noticed any improvement from it but its very well likely that I could have both (a) interaction from reflux and allergies, or (b) reflux that took longer than 14 days to heal. Regardless the pulmonary doc seemed highly skeptical of reflux as a diagnosis considering my healthy disposition; instead he concluded to allergic rhinitis.
posted by prunes at 5:05 AM on April 29

Sorry, I'm not familiar with US medications or prescribing practices. I'd be surprised if they couldn't give you a syrup or gelcaps that only contain DXM. Otherwise, I believe that it is still unscheduled in the US so you could legally buy powder through less reputable channels.

It will only provide symptomatic relief but if it's affecting your life so much it'll probably be helpful.
posted by turkeyphant at 5:21 AM on April 29

Same thing here. Two things that have helped the symptoms of whatever it is: the above mentioned tessalon perles, and a humidifier ~ don't know if it's crazy dry where you are, but I find that the humidifier keeps my sinuses in good shape which minimizes the whole chain reaction.

But I'm definitely going to look into what stray thoughts said.
posted by kattyann at 6:19 AM on April 29

I had your problem when around 20 for a year or so, went through all sorts of exams, therapies and cough suppressants (which only work this much) until they swabbed my tonsils and cultured the result, and then gave me specific antibiotics for that. Solved in a week.
posted by _dario at 6:21 AM on April 29

I can't believe no one suggested this yet, but have you checked your tonsils (if you have them) for tonsil stones? I have allergies and post nasal drip, but it took me years to figure out that my chronic throat clearing was because of tonsil stones. According to people on the forums of tonsilstones.org, doctors who aren't ENTs, and often ENTs even, have no idea what they are.

(I haven't gone to the doctor for mine, but I've found that, when I'm clearing my throat a lot, I can just clean out my tonsils with h2o2 and a Q-tip and it goes away).
posted by PhoBWanKenobi at 6:42 AM on April 29

I get a chronic cough if I get a cold, and in the winter, it will last until the weather warms up. Menthol is the active ingredient in many cough drops. It works well for me because it opens up my constricted airways. Over time, I learned that my chronic cough is caused by inflammation, and best treated with a steroid inhaler and mentholated cough drops (Halls - the generic sugar free version. The sugar was bad for my teeth.) It always improves in warm weather, and is much worse if I have to be outdoors in very cold weather.
posted by theora55 at 10:06 AM on April 29

I just saw a specialist for this very thing -- a dry cough that lasted for years. All the "usual" suspects were ruled out.

When I saw the specialist (3 weeks ago now), he diagnosed me with a combination of low-level allergies to many different foods (related to Oral Allergy Syndrome), and low-level acid reflux.

He put me on Prilosec OTC 2x daily; a saline nasal spray 8x daily; and a serious diet. The list of things I can't have is long, here are some of them:

dairy products of any kind
tomato products of any kind
soda
alcohol
chocolate
citrus fruits
spicy food

Additionally, I must eat 4 cups of vegetables each day, and 4 cups of fresh fruits. Several things I regarded as vegetables do not count -- corn, peas, beans (except green beans), and a few that I'm allergic to.

Because of allergies to specific foods, finding veggies and fruits that I could stand to eat 4 cups of per day wasn't fun .. but I did it.

I am adhering to the diet, and taking my meds religiously, and it is making a difference. My cough is not completely gone, but I have a coughing spell about once per day instead of nearly constantly.

BTW I also was diagnosed as healthy otherwise. We eliminated asthma due to the fact that when physically active, my friends have a hard time keeping up with me; I hike / bike regularly, and have no pulmonary problems, although I did have tuberculosis some twenty years ago.

Good luck getting this fixed, good on you for consulting the doctor earlier rather than later (I didn't complain about the cough until I was 45 years old).
posted by dwbrant at 11:44 AM on April 29

Regardless the pulmonary doc seemed highly skeptical of reflux as a diagnosis considering my healthy disposition; instead he concluded to allergic rhinitis.

I don't see why having allergies rules out reflux or why this one doctor disagrees with the others without a barium meal. Being healthy has fuck all to do with it, I'm bursting with health, am competing in a half marathon in a couple of weeks, and have reflux. Low level reflux doesn't always have obvious symptoms besides the type of coughing you've been having.

Acid reflux is the third most common cause of chronic coughing (after smoking and asthma), it's definitely something you should be ruling out definitively. Which you haven't done yet. A barium meal is is easy, non-invasive, totally non-painful test that takes an hour or so. Get it done. In the meantime Prilosec or whatever won't hurt you if you don't have reflux (assuming you tolerated it before), go back to taking it. Get on top of the allergies too (FWIW I don't all of what I'm allergic to exactly, but it doesn't matter because the treatment is still antihistamines and steriod nasal spray) since they just suck anyway.

It's fairly clear from your descriptions that whatever this is it has caused long term damage (including that now-over-active cough reflex), it's highly likely it will take more than 14 days to heal.
posted by shelleycat at 4:05 PM on April 29

I spoke with the doctor again today. He's giving me another bout of steroids: now I'm going to be on a longer cycle of prednisone, and he wants me to continue with the clarinex, singulair, and nasonex. He reiterated his suspicion of allergic rhinitis because of how exceptionally inflamed my nose/throat appeared to him. *fingers crossed*
posted by prunes at 8:29 PM on April 29

Don't know if this is helpful or already covered, but... I had a similar situationg going, and it wasn't until I was diagnosed with a dust mite allergy did anything change. Took some allergy medicine for a while which did seem to help a bit, but what helped the most was putting a cover on my mattress and pillow to protect from dust mite residue. It sill cough a bit but not nearly as bad as I did before. So yeah definitely check the air in your home and try to see if you have a dust mite allergy.
posted by pyro979 at 2:02 PM on April 30