Fix my chronic cough! Dr's can't!

January 1, 2007 5:47 AM

I have had, for as long as I can remember (maybe 15 years) a chronic cough that, at times, makes me insane.

I have seen two ENT Dr's about it and have gotten nowhere. I've gone to allergists and nutrutionists to no avail. I'm waiting for my primary to schedule an appt with a super-special 'cough specialist' but I figured I'd throw it out to you good folks.

There is no one thing in particular that triggers it and I can't remember how it started. From what I can tell, when I go out in the cold it seems to get worse, when I eat Oreo's it seems to get worse, when I get stressed or anxious it seems to get worse. All other times, its just there.

It feels a little like post-nasal drip the just won't go away. I can always feel something in the middle/back of my throat. The crazy part is that is if I squeeze the lowest accessable part of my throat (at that U-shaped chest bone) it effectively 'scratches' the itch and makes it go away for a few seconds.

I've tried reflux meds and they did nothing. I've tried cough supressents and allergy meds too. One doctor suggested that it was psychological which, I'm told, is their way of saying they can't figure it out. I've been scoped several times and dr's can't find anything wrong with the inside of my throat.

What do you guys think? This is driving me crazy and I fear that it will last forever.

posted by Thrillhouse to health & fitness (29 comments total)

I had this, too. (I used to say I got a cough twice a year and it lasted six months each time.)

20 Years, plus, I had it. I did courses of meds for mycoplasm infections, allergy meds, had a bronchioscopy, modifed my diet, tried narcotics (codeine cough syrup that the doctor called 'the private stock), and could develop no correlation between it and anything else. I did allergy tests, prophylcatic consumption of various nasal congestion aids. The most effective thing I found to stop it was Nytol, an over the counter sleep aid/antihistamine, which had the negative effect of making me sleepy.

I had it in Western NC, where I lived, in Lubbock, TX, and in Denver, CO. I had every conceivable explanation, none of which were true, including the 'nervousness/psych' bullshit.

When I got involved in a non-profit centered in Vermont, I started travelling here and found that it went away and came back when I went home to western NC.

Long story short... in my case I think ambient air quality was the biggest thing. I suspect a subclinical allergic reaction, centered in my upper bronchii. Here in Vermont, home to some of the cleanest air in the nation, I do not have it. When I visit WNC, I get it again. Once, on a car trip, when we hit northern Virginia on I-81 South, I awoked from a sleep coughing, pretty much at the VA border.

WNC has bad air.... Los Angeles bad. Great Smokies National Park has an ozone monitoring system and more bad air days than LA. TVA and Ohio Valley industry pump sulphur dioxide, particulates and nitrous oxides into the air, and it is bad. That's what I was breathing.

Sorry for the extended post, but check with clean air advocacy groups in your area and see what you are breathing. Schedule a 1 week vacation to Brattleboro or a ski resort like Stowe, and see if it goes away or moderates. Pay attention. Docs have no better reasoning skills than you do, statistically. Good luck. (Shoot me an email, if you wanna and we'll chat more. I am already way too wordy with MeFi, but I am happy to share experience with you. )
posted by FauxScot at 6:07 AM on January 1, 2007

'awoked'... jeez. I should have stayed in Western NC!
posted by FauxScot at 6:09 AM on January 1, 2007

I suffer from a similar cough and I too have yet to find a doctor who can tell me what it is. A few have said they think its allergies, but no matter where I am (and I travel a lot) it doesn't go away. I do find that when I take deep breathes it makes the coughing worse... but the docs say that is just a coincidence.

On a side note, my wife gave me an article recently that noted some cases of chronic coughing can be caused by acid reflux disease. Might be worth looking into.
posted by tundro at 6:54 AM on January 1, 2007

I don't have anything that chronic, but I do suffer from allergy related post-nasal drip that causes a persisten annoying cough from time to time. I have found a similar thing to FauxScot, that it comes and goes with travel, so the air quality seems to have a lot to do with is, as does (I suspect) the local trees, grasses and other plants. So, it still could be allergies and you're just not hitting a very patient allergist (which is entirely possible - I work with doctors every day and on the whole they are NOT a patient lot... no offense to any docs reading, but it's true in my institution). Find an allergist that's really willing to work with you over time and maybe even catalog when it gets better and worse (like you already seem to be doing).
posted by smallerdemon at 7:37 AM on January 1, 2007

FauxScot,
I'm going to try your method. My friend is a pharmacist and she tells me that Nytol is the same active ingredient as Benadryl, so that probably explains why it works for you.

I'm going to give it a try for a week or two and see if that works. Definitely not reflux. I did try reflux treatments and it did nothing. Still, any info from others would be great!

I'm in northeast MA, if it helps.
posted by Thrillhouse at 7:59 AM on January 1, 2007

Your thyroid is almost exactly where you describe squeezing. Has your thyroid ever been tested? Visually examined via scope?

Something to think about.

Also, don't dismiss the "nervous tic" thing out-of-hand.

It may not be the most likely, but it could go a long ways towards describing why it has been so lengthy and so far not medically indicated.

I'm not saying that's what it is, I'm just saying keep your mind open. I have an uncle who suffers severe, almost absurd, allergies most of the year, and clears his throat constantly. This leads him to, even during the few months he has some relief, to continue clearing his throat every few minutes as it has become an almost involuntary reflex over the last 30 years.
posted by Ynoxas at 8:08 AM on January 1, 2007

ynoxas, How does one test a thyroid?

Also, I'm not entirely dismissing that it is psychological, I would be willing to be 'tested' for that too. Its just that no one has offered a solution for a nervous tic (doctors, I mean, not you guys). Any thoughts on how to determine if this is the problem and what to do about it?


Thanks again, for all your help!!
posted by Thrillhouse at 8:16 AM on January 1, 2007

Hmm, have you ever tried cutting dairy out? People have scolded me for claiming dairy ups your mucous production but several doctors have suggested otherwise; in my experience it does help. I'm asthmatic and have fewer symptoms (especially the nagging back of throat itches caused by postnasal drip) but not enough that this is always the case with my diet.
posted by shownomercy at 8:42 AM on January 1, 2007

Second the thyroid checkup.

My mom had that cough/tickle/itch since before I was before -- always hacking away. Recently she was diagnosed with thyroid cancer and had both thyroid glands removed. Since the operation, her cough has pretty much disappeared.

Note: I am definitely not trying to suggest that you have thyroid cancer as IANAD. I'm just throwing my anecdotal evidence on the pile.
posted by milarepa at 8:47 AM on January 1, 2007

I can't add much except for that I feel your pain. Read on for my chronic cough history.

I had a chronic all-winter-long cough while living in Ann Arbor, Michigan. It would start with a cold every fall, and, oddly, end with a cold in the spring. I'd get a cold for a few days and when it went away, so went the cough.

I moved to Texas and the cough was not present for 9 years. The tenth year, I got it for about 4 months in the spring.

Moved to Portland, OR and it came and went, at first with colds as in MI, but then it deviated from that pattern and became uncorrelated with season or cold frequency. I've pretty much had it for 4 years straight now. I'm 37.

The allergist I saw two years ago did a dilation test. She tested my exhale volume, had me inhale a bronchial dilator, then tested it again. Before the dilator I was at 80% capacity for my size, after, 100%. That indicated to her that the cough was due to swollen bronchioles probably due to an allergen. She treated with various anti-histamine and anti-swelling meds including prednisone. These had varying effects on the cough, but never knocked it out. Like you, I wanted to know WTF was causing this. Merely treating the symptom (and never completely) wasn't satisfying. At one point the nurse told me, "We don't know what it is, but we're an allergist, so we'll treat you for asthma and if the cough goes away, that's what you had." That was the extent of the scientific method in that office. I also tested positive in the skin scratch test for allergy to cats and dust mites. I replaced all of the carpets in my house with hard woods and put covers on all of the mattresses and pillows. Vacuumed a lot. No love. Every visit, the Dr would ask me about "attacks" and wheezing and other asthma related symptoms of which I had none. And she kept suggesting I start a years-long course of allergy shots. It seemed like profit-focused assembly-line medicine to me--I got tired of telling them that I had no asthma symptoms except the cough and eventually stopped making appts. I tried a new Dr. An ENT this time:

The ENT looked at my larynx and called it "hypo plastic"--swollen and shiny. It was irritated and, to him, a strong indicator that the cough was due to reflux. Acid was getting up there and irritating my vocal cords. I took the antacid meds, raised the head of my bed, and refrained from eating after 7 PM. The cough remained. He did a CT Scan of my sinuses and a chest x-ray to rule out cancer or some other unlikely lung problem. Nothing there. I asked him if the cough could be causing the reflux or larynx irritation instead of the other way around. He said that it was definitely possible. I figured it could be the same for the swollen bronchioles the allergist measured. The constant coughing was causing the irritation and swelling.

That's where I am now. I recently joined the ski patrol on Mt Hood and noticed that I do not cough up there. The air is probably cleaner. Thinner. Somewhat colder. The cough is so annoying, I'm almost willing to relocate to be rid of it. A mountain cabin would be fine with me!

I empathize with all who have this. It's really a pain to do business on the phone or run meetings when you can't talk for 10 seconds without coughing.

Best of luck to you. 15 years is a long time!
posted by nonmyopicdave at 8:55 AM on January 1, 2007

Thrillhouse....

I did notice/do notice that mine had a slightly positional nature. Sleeping on the left side versus right made it worse at night. Gives some credence to post-nasal drip origins.

Dextromethorphan hydrobromide is the active ingredient in Nytol. Compared to the codeine, it worked 7 on a 1..10 scale as oppsed to 2 for codeine.

It might help to keep super accurate records for a while. Coughs/minute, dietary inputs, air quality, inside/outside, exercise, etc. to see if you can get a handle on anything that correlates.

Really, it's maddening and I feel for you. Aggravating as hell. Vermont did not cure me, but it did cut it down to .01 on a 0..10 scale. Almost non-existent now.
posted by FauxScot at 9:01 AM on January 1, 2007

The physical sensation you describe sounds like what is called Plum-pit Qi in Chinese Medicine. The sensation of something caught in the throat that you can't swallow or cough out. Since you have gone down the western path so long and they have come up with nothing maybe you should try a medicine that treats nothing (they say) and get to an acupuncturist.
posted by pointilist at 10:40 AM on January 1, 2007

You may have slight dysphagia. Do you ever "miss" the odd swallow, so that a tiny bit of food or liquid goes down the wrong pipe?
posted by weapons-grade pandemonium at 11:20 AM on January 1, 2007

I've tried acupuncture before, but not for this. I'm certainly willing to try it out. I don't have a problem swallowing.

:)
posted by Thrillhouse at 11:36 AM on January 1, 2007

Some people react to a by-product odorless gas (or particle?) that is created when people use natural gas to heat a home. Or restaurant.

You say you think it might get worse when you go out in the cold - could that mean when you go out in the cold to that certain restaurant that uses gas heat? or maybe you are bothered by a certain wood in a wood burning stove (I've heard cottonwood burning makes some people react).

At home, could you be reacting to how you heat your home or how a neighbor heats their home?

I think taking notes would help. Write down everything you eat, what kind of air you are exposed to then rate your coughing 1 to 5 in a second column.
posted by cda at 12:04 PM on January 1, 2007

Horrible Mental Image Alert.

My father as a child had a year 'round persistent cough, which Grandma mentioned to the doctor on a visit to the house. (They did that back then.) The doctor commented his uvula was too big and hanging in the way, causing the throat to tickle. He suggested the kid open his mouth so he could see that again, whipped a pair of scissors out of his pocket, and cut it off. Family folklore says the kid never coughed again.

(The plural of anecdote is not data. That's just to give you something else to google, or ask about, although I would have thought they'd have found it by now if it was that obvious.)
posted by unrepentanthippie at 12:05 PM on January 1, 2007

When I was a kid, I used to get a horrible, tickly itch in my throat. I would cough to try to scratch it, but it kept coming back. As an adult, I discovered that my soft palate was hanging down and blocking my airway. Surgery fixed it. I'm pretty sure that the childhood tickling feeling was the soft palate (the "ceiling" so to speak) hanging down, lightly touching the "floor" of the throat.

For a number of years I had a persistent cough. Even a lung specialist couldn't figure out the cause. It's mostly gone now; I strongly suspect it was the result of gastric reflux (I was diagnosed with it a few years later). That is, the acid creeping up my esophagus and irritating my throat.
posted by Clay201 at 12:52 PM on January 1, 2007

Good god. I didn't read unrepentanthippie's post until just now. First, it's weird because I've never heard of anyone else even suspecting that they had the same problem I did. Second, that's just one fucking scary ass story. A pair of scissors?? Jesus.
posted by Clay201 at 12:55 PM on January 1, 2007

Your cough may not be due to just one of any of the above problems, but three or four things happening at once. I had this problem as well, and I finally went to a lung specialist who specialized in "chronic cough". Prior to that I had an ENT who had treated the acid reflux and allergies, and chronic sinus infections. But I still had a bad cough. At the lung specialist's it was discovered that I had asthma that he called "cough based" asthma. Meaning, it can't be diagnosed listening for a "wheeze" in the lungs because it's not in the lungs. It's in my bronchial tubes, which were greatly inflamed. He put me on steroids and then I went on Advair and a rescue inhaler. This cleared up a lot of the cough, but stil, it was there. Finally, they put me on medication for post nasal drip. The cough is under control, but, it is a delicate balance to keep all these things at bay. The myriad problems led me to begin exercising to lose weight so that I can greatly reduce my acid reflux and hopefully, my asthma.

The chronic cough is a weird, complicated and misunderstood problem. It has also taken me 15 years to get it to the point where I can sleep without coughing all night. I wish you luck, and also, assertiveness. Continue to seek an answer, don't be deterred by doctors who are baffled or can't find a source.
posted by generic230 at 1:08 PM on January 1, 2007

A good friend of mine has a chronic cough, and he pursued many lines of treatment. I'm sure there are many possible causes. One complaint he had was that most over-the-counter allergy medications have a cocktail of medicines, and he always wanted to be able to try each individual drug on its own to see which was most effective. You can usually get a prescription for them singly but it's expensive to buy that way. Anyway...

One autumn he went on vacation to Massachusetts, where it was quite humid. His cough went away. He lives in Northern CA, which is pretty dry by comparison. You might consider this possibility. Try going somewhere tropical and see if that helps. It might at least give your doctors some clues. Perhaps a home humidifier is a cheaper way to experiment than travel?
posted by scarabic at 1:21 PM on January 1, 2007

Have you been tested for asthma? Many doctors can overlook asthma as a diagnosis because many asthmatics have the "weeze". I suffer from an asthma cough and it can be very difficult to treat as it is seasonal. It's frustrating, exausting and difficult to find the right treatment, usually when I'm at my wits end and nothing else works, my doctors prescribes me prednisone, which is really effective in supressing the cough and clearing it up for the time being. I live in a dry climate and it seems to be triggered much more then when I am somewhere humid.
posted by bluehermit at 1:44 PM on January 1, 2007

Clay201: That happened around 1925. (Fortunately, that far back, they did not worry about blood or pocket borne diseases.) The same doc removed a burst appy on the kitchen table under ether, and although Dad spent 3 months in bed recovering, he lived.
Guessing that's not the OP's problem, it will turn out to be air quality or multi-issue or both, but I'd feel bad if I did not offer them the chance to consider it.
posted by unrepentanthippie at 5:50 PM on January 1, 2007

Are you on any medication? I was prescribed a high blood pressure med that has a known side-effect of causing a tickle in the throat. It was most annoying and the doc changed it to something else. My apologies for not remember what the drug's name is.
posted by deborah at 11:46 PM on January 1, 2007

I know of someone who quit drinking diet soda with nutrasweet and his cough went away.

Do you consume much nutrasweet?

Just a possibility.
posted by tbird at 12:10 AM on January 2, 2007

I have a serious lung condition and found that ambient air quality generally relates to this.

- Calgary (home) - no real heavy industry - no cough.
- Edmonton - refineries, ton of diesel traffic - within 24 hours, cough. Takes another 24 hours to dissipate once I've left.
posted by jkaczor at 5:03 PM on January 2, 2007

You might try plantain tea (yes, the common lawn weed) which can help long-stuck stuff come out, be in splinters, particles in the throat, etc.
posted by Riverine at 3:03 PM on January 5, 2007

I know a guy on blood pressure medicine who has a hacking, nasty cough when the blood levels come up and go down on his meds. He only coughs during the change part though. (That's for posterity and future searches.)
posted by unrepentanthippie at 4:07 PM on January 7, 2007

I just found this website & I'm thrilled! I too have a CRONIC COUGH! It's been about 1 1/2 years. I'm loosing my mind & ready to try anything. I've been to a ENT & I was told it was Acid Reflux (which I do have... I've had it my whole life & I've been taking medication (Prevacid) for several years.

However, one Dr did suggest I take my Prevacid in the morning & then take one at night. I did this, & when the cough didn't subside, he remarked, "I didn't think it would."

What's strange, is that if it is due to Acid Reflux, why haven't I been coughing my whole life? (I do drink red wine, but I've stopped drinkiing regular coffe & caffinated sodas, & yet it continues).

What's more, I can remember exactly when it started; April 2006. I had a really bad cold with a bad cough; the cough just never went away. When I mention this to Dr's they pretty much disregard it.

What else is weird is that whenever I'm calling someone, right before I begin to speak, I cough. When I approach someone at a store, before I address them, I cough. I do cough more when I'm stressed as well (I have a 3 1/2 year old, so I'm pretty much always stressed).

My husband is convinced it's the L.A. pollution; last year we took our son to Hawaii & I don't think I coughed hardly at all (possibly due to cleaner air)?

I really don't know what to do anymore. If anyone has any suggestions, PLEASE TELL ME!!!!!!!!!!!!!! I'M DESPARATE.

Thanks-

Chadney
posted by Chadneyann at 9:10 PM on October 17, 2007

Chadney:
I see you joined just for this.
If you follow the tags in the upper right hand corner of this page, you will find more discussions similar to this and may find some suggestions of use to you.
Just so you know: We don't sign our posts around here; it's a little different culture than most places. If you want to hang around, please read the FAQs, and we look forward to your participating. Wishing you well with the cough.
posted by unrepentanthippie at 12:09 PM on November 11, 2007