What to do about a chronic dry cough?

August 1, 2009 4:43 PM

I've had a chronic dry cough for going on two weeks now and two doctor's visits later it's not clearing up. Can anyone give ideas on what could possibly be causing this?

About two weeks ago I came back from a weekend trip with a mild respiratory infection--a hacking cough with lots of mucus. No other symptoms, no fatigue or fever, no runny nose, nothing. A few days later, the mucus cleared up with no incident, but the cough has continued and even worsened. It's now a chronic dry cough that keeps me up at night and has given me fits so bad I've vomited a couple of times at the end of them.

I tried Robutussin, sleep aids, gargling with salt water, and tons of Throat Coat tea with honey and lemon. Earlier this week I saw two different doctors. The first I saw on Tuesday, he said it was a cold virus and prescribed Hycodan and antibiotics (?). The Hycodan allowed me to sleep deeply in between fits, but I woke up dizzy and with an awful hangover once the dizziness wore off. I haven't taken the antibiotics because the doctor called it a virus and I think he was giving them to me to shut me up.

On Wednesday, I saw the second one and she diagnosed bronchitis. She prescribed an inhaler (Ventolin) to control the fits and Promethazine-DM cough syrup (without codeine). Wednesday night it worked great. Thursday, it worked less great. Friday, I slept well in between fits but had just as many coughing fits as ever, and it took longer for them to stop. Today, the coughing fits are the most frequent they've ever been and are not responding to either medication. Additionally, I now have the sensation of something trickling down the back of my throat that's making me feel like I'm on the verge of choking.

The medications are getting less effective, the cough is not getting better. I'm planning on calling the second doctor but I don't know how soon they'll be able to see me. I don't have insurance so the emergency room is not an option.

I have never had allergies or anything like that. I still don't have any other symptoms. I work in a warehouse so my job is pretty dusty, I'm thinking that may not be helping things but I wore a dust mask today and it didn't seem to help.

Does anyone have any ideas on what could be going on?

posted by schroedinger to health & fitness (24 answers total)

Here's some info on chronic dry coughs.

Take your antibiotics. If you've got an infection that's causing lung issues, that will help.
posted by dejah420 at 5:00 PM on August 1, 2009

Post-nasal drip
posted by jschu at 5:00 PM on August 1, 2009 [1 favorite]

Hmm, definitely go back to the doctor. I am not a doctor so YMMV but what you describe sounds an awful lot like how I was when I had whooping cough.

How old are you? Have you had a whooping cough booster vaccine as an adult? The vaccine for whooping cough wears off just five to 10 years after the last dose, meaning adults who got their childhood vaccination are susceptible to the disease.
posted by gudrun at 5:04 PM on August 1, 2009

The trickling down the back of the throat makes me think sinus infection, for which antibiotics usually work. My last sinus infection morphed into a plague that involved coughing until I felt like I was going to vomit. I had very little sinus congestion; it was almost entirely a cough from post-nasal drip.

You might want to call doctor #2 and tell her about the antibiotics prescribed by doctor #1 and see if she says, "Give those a try." Then fill the prescription immediately and start taking them, because it could take a few days to see an effect. You should be able to get a response from the doctor or her nurse the same day of your call.
posted by PatoPata at 5:05 PM on August 1, 2009 [1 favorite]

I didn't think I had allergies either until I came down with a chronic dry cough due to post nasal drip. After lots of tests, chest x-ray etc. it was determined I had seasonal allergies. Maybe you could check into that. My symptoms were just like yours - coughing so bad that I vomited, kept me up at night, no other symptoms really. Just a thought.
posted by fresh-rn at 5:10 PM on August 1, 2009

Try some saline nose spray. Seriously. If you have an unnoticed postnasal drip that can give you the symptoms you describe. But still, follow up with your doc.
posted by St. Alia of the Bunnies at 5:17 PM on August 1, 2009 [1 favorite]

I am not a doctor, but that sounds like whooping cough (which I have had). The coughing fits that make you puke are NOT normal bronchitis. For what it's worth, antibiotics don't work for the symptoms, it just has to run it's course, but the antibiotics do keep you from transmitting it to others.

If that is actually what you have...
posted by kathrineg at 5:27 PM on August 1, 2009

Heartburn - try some prilosec.
posted by Unred at 5:27 PM on August 1, 2009

This might sound off, but if you have an air conditioner, check the filter and either replace it or clean it out really well. If you do the "open windows" thing, try to keep them shut for a few days, with curtains drawn to keep the inside temperature down. Dry cough can be environmental. If you started out ill, your airways might be hypersensitive right now to things like dust or the crud that accumulates in the a/c filter.
posted by SassHat at 5:30 PM on August 1, 2009

I was also going to go with postnasal drip caused probably by allergies. You can get new allergies as you age, as I have sadly found out. You could always try taking some claratin and/or sudafed (OTC but gotta ask the pharmacist). If it is allergies the claratin will make you almost immediately feel better although it might not knock out the cough, which is what the sudafed helps with.
I also second the saline nasal wash for daily use if it is in fact allergies or postnasal drip. I really like NeilMed myself (very easy to use).
posted by ch1x0r at 5:31 PM on August 1, 2009

A cough usually hangs around for a while after a chest infection, and can take up to a month to die down. To mitigate it drink warm water - not from the tap.
posted by mattoxic at 6:21 PM on August 1, 2009

Get a laryngoscopy.

This sounds a lot like what I had a few years ago, although not as severely as you. It took months of mild antibiotics and incorrect diagnoses (allegries, post nasal drip) before an ENT specialist looked at my larynx and saw an ulcer on my vocal cords. In the end it was fixed with a strong antibiotic and a cough suppresant (since the ulcer wasn't healing due to all the coughing).
posted by kevinht at 6:39 PM on August 1, 2009 [1 favorite]

My mom has a chronic cough and her doctor is trying her on antacids right now. He thinks it's acid reflux. He said 60-70% of chronic coughs are caused by that. No idea if that includes dry coughs or not.
posted by IndigoRain at 7:02 PM on August 1, 2009

Could be anything, see a doctor, certainly could be a post-viral cough.
posted by gramcracker at 7:10 PM on August 1, 2009

i had a long standing dry cough recently that i knew was caused by allergies. i kept taking claritin-d and every day the cough got worse. i was drinking so much water and it just wasn't helping. then like a light bulb i realized the decongestant was drying me out too much and even though i felt my head might explode due to mucus, i switched to just regular claritin for a few days and now the cough is basically gone.
posted by nadawi at 8:20 PM on August 1, 2009

Go back to the doctor, or find a different doctor. IANAD, I totally don't think this is what you have, I'm not saying this to freak you out, etc, BUT: your symptoms sound very much like when I was first developing heart failure, down to the cough syrup and inhaler helping for a little while and then not. It sounds like when kathrineg and gudrun had whooping cough; it sounds like when kevinht had a vocal cord ulcer. There are too many possibilities ranging from the completely innocuous to the potentially deadly. Searching for an internet diagnosis when the symptoms are this non-specific is a road to madness. A doctor who can actually see you and do tests is really the only right answer here (and I say this as a big fan, in general, of internet diagnoses).
posted by katemonster at 8:53 PM on August 1, 2009

Honestly, when I had a cough like that (after 2 weeks of pneumonia, I had coughing fits that made me throw up five times a day for a year) I tried all kinds of drugs, and at one point the doctor just decided I must have asthma because they didn't know what else to do. I didn't.

What made it stop? Working out regularly. Yeah, I know, it's crazy. You should go to the doctor and try all the drugs anyway, you'll have to, but try working out as well.
posted by jenfullmoon at 10:25 PM on August 1, 2009

Not being asthmatic ever and then sharing a recent case of bronchitis with my kid I learned about pathogen induced asthma. The bronchitis diagnosis was confirmed by immediate response to antibiotics, and the asthma was detected through listening to my lungs. My asthma was treated with normal inhaled corticosteroids and benzonatate cough suppressant and ended after about 2 months. Since that time, I've had no recurrence of asthma like symptoms or coughing.

IANAD and I didn't know pathogen induced asthma existed. As the diagnosis can be made with a stethoscope and some deep breaths, it's probably worth asking about. The syndrome was much as you describe.
posted by fydfyd at 11:20 PM on August 1, 2009

I am not a doctor, but that sounds like whooping cough

There's a vaccine for whooping cough and since schroedinger is from Joisey he's probably had it. There are something like 7000 cases of whooping cough in the US per yer. I'm guessing you weren't vaccinated?

I'm not saying it's impossible he has whooping cough but as the doctors say, when you hear hoofbeats look for horses not zebras.
posted by Justinian at 1:09 AM on August 2, 2009

Only infection with pertussis (whooping cough) confers life-long immunity; the DPT vaccine is not life-long, and pertussis rates are going up now again due the anti-vax crowd.
posted by gramcracker at 6:17 AM on August 2, 2009

My S/O had a dry cough for a few months after working on a jobsite where he was allergic to some unknown allergen. It just went away one day.
posted by Rocket26 at 7:27 AM on August 2, 2009

I was vaccinated but it does wear off and according to my pulmonologist, it is underdiagnosed, at least in NYC. Of course, I hope it is allergies or something like that.
posted by kathrineg at 10:23 AM on August 2, 2009

Um, please note that I was vaccinated for whooping cough as well, but as kathrineg says and as I indicated as well, the vaccination does wear off. Note that I had whooping cough when I lived in NJ, so it is very possible for schroedinger to have it if he has not had a booster shot for it. I agree that other causes are probably more likely, but whooping cough should not be discounted.
posted by gudrun at 5:27 PM on August 2, 2009

Just to come at it from a different angle... I had a bad cold in early April that resulted in a miserable, lingering, oh-god-will-I-ever-sleep-again dry cough that lasted about six weeks.

In the middle of May, I went into the urgent care (and eventually the hospital) for an upper gastrointenstinal bleed following many months of mild but semi-chronic stomach pain (they originally thought I might have an ulcer; they eventually settled on gastritis). For treatment, they put me on a proton pump inhibitor that not only stopped the bleed -- it stopped my cough dead in its tracks in under 24 hours. According to my doc, a persistent dry cough can sometimes be a symptom of gastritis, even if it's triggered initially by a cold or flu.
posted by scody at 7:59 PM on August 2, 2009