Help me get to the bottom of a constant cough
June 21, 2011 5:42 AM   Subscribe

Snot & Sickness Filter: I've had a hacking cough for years and I'm finally ready to get to the bottom of this. What do I need to ask my doctor? What avenues are smart to pursue? Anything I can do to calm it down in the short term?

YANMD, obviously. But frankly none of the doctors I've gone to in the past have been much help. When I explain I have a nagging cough that I've had for years I get suggestions like "Try Robitussin." (I did, it doesn't help) And have generally left me with the impression that there's not much to be done about it, and it's nothing to worry about. But it's freaking annoying to me and everyone around me. I'm planning on getting a new primary physician and I'd like to try again. Please help me ask intelligent questions and not let my doctor railroad me.

I think it's Post Nasal Drip. I'm always coughing, but it's worse in the winter than the summer. It's worse in the mornings than the evening. It's much worse when I'm stressed out. I tend to cough up clear, runny mucus, but sometimes some of the thicker, yellow stuff. And sometimes the coughing doesn't bring up anything at all.

That's about all the details I can think of. Um...I'm pretty anemic. I don't know if that could factor in at all.
posted by Caravantea to Health & Fitness (31 answers total) 2 users marked this as a favorite
Go see an ENT or an allergist.
posted by TheBones at 5:48 AM on June 21, 2011 [3 favorites]

Have you tried antihistamines? Coughing and clearing of the throat can also be a sign of acid reflux.
posted by jenny76 at 5:49 AM on June 21, 2011 [1 favorite]

Also, you aren't on BP meds by any chance, are you? Some of them cause frequent coughing.
posted by jenny76 at 5:51 AM on June 21, 2011

IAMAD...etc. - but post nasal drip is a symptom, not a condition.

I was also 'diagnosed' with post nasal drip, which aggravated my existing asthma. Turned out that i had GERD (essentially bad acid reflux), which was causing my sinuses to be inflamed. I was contsantly clearing my throat because it was also inflamed, and there felt like a thick coating of mucus on it.

The reflux occurred mostly at night (because I was lying down), so it was worse in the morning.

You should see an ENT.
posted by His thoughts were red thoughts at 5:53 AM on June 21, 2011

Go see the doc, and get a ref for a good ENT specialist. In the meantime, try some Claritin or Allegra if you suspect PND - you might just have persistent allergies year round (I do.) It may take a few days for the allergy meds to kick in, I'd give it a solid month and see how you're doing at the end of it.
posted by Slap*Happy at 5:55 AM on June 21, 2011

I also had the same symptoms, that ended up being caused by GERD. You might be able to get away with simply taking OTC Prilosec (or one of the others), or if it's really bad you could need an upper endoscopy to clean out damage to your esophagus brought on by years of untreated GERD.
posted by COD at 6:07 AM on June 21, 2011

Response by poster: Question about GERD. Is this likely when I don't ever have heartburn?
posted by Caravantea at 6:13 AM on June 21, 2011

When I was diagnosed witih reflux about 18 months ago, after developing a wheezing cough that sounded like asthma and made me feel like I couldn't breathe, I didn't have anything I recognized as heartburn. The cough and a persistent tickle in my chest were the main symptoms. I now recognize some of the sensations as reflux-related when they act up, but prior to my diagnosis and treatment with meds, I didn't think of it that way, and it doesn't feel like what I think of as "heartburn." So, yes, it's possible that you are dealing with GERD even though you don't have heartburn.
posted by not that girl at 6:26 AM on June 21, 2011

See an allergist. I had to throw a minor temper tantrum to finally get a referral to one - who then determined that I was allergic to a whole long list of things that I would have never suspected! (Seriously, hamsters? Who's allergic to hamsters?!)? Finally getting allergy tested literally changed my life.
posted by MexicanYenta at 6:46 AM on June 21, 2011 [1 favorite]

My cough was a combination of reflux, allergies, and a side effect from another medicine I was taking.
posted by Obscure Reference at 6:53 AM on June 21, 2011

Yeah, see an ENT. My bet is Chronic Sinusitis.
posted by MeiraV at 6:56 AM on June 21, 2011

My cough that was merely annoying, then just wouldn't go away turned out to be chronic asthma, that I've apparently been living with since childhood. Get a new/second opinion for sure.
posted by pixiecrinkle at 7:04 AM on June 21, 2011 [2 favorites]

IANAD. For me, I had a chronic stuffy nose and and post nasal drip - until I stopped drinking milk. Seriously. I'm not sure if that means it is an allergy to milk, but that's what did it for me.
posted by jillithd at 7:24 AM on June 21, 2011

This is an obvious question, but do you smoke? Or live in a polluted city?
posted by katypickle at 7:32 AM on June 21, 2011 [1 favorite]

I'm not a doctor either, but I had similar issues all last year; the miracle pharmacy in my neighborhood* suggested that maybe I just had low-level allergies that were causing post-nasal drip in my sleep and that lead to coughing. They suggested I try Mucinex and that's helped a hell of a lot.

* "Miracle pharmacy" is a mom-and-pop place in my neighborhood that has always been able to come through when I have this low-level and annoying health issue; I walk in, I tell them my issue, and they instantly know what to recommend and it always works.
posted by EmpressCallipygos at 7:33 AM on June 21, 2011

I'm actually shocked that when you said "nagging cough" your doctor didn't immediately shout "GERD!" and throw a bunch of Zantac at you. It's one of those conditions that's being overdiagnosed as a catch-all for lots of problems, but yes, nagging cough with no actual heartburn is one common presentation.
posted by tetralix at 7:36 AM on June 21, 2011

Get checked for asthma, too. There is a type of asthma known as cough variant asthma that presents only as a cough, sometimes with wheezing and sometimes without. It was an allergist who finally diagnosed me 15 years ago after years of primary care physicians throwing cough syrup at me. If all they do is make you do that stupid breathing test in the tube and then say your lung function is fine, they have not properly checked you - cough variant asthma does not tend to hurt lung function. It's my understanding that the only way to tell if you have it is to throw things they know you're allergic to at you and see if you cough, or to give you an asthma treatment (inhaler, nebulizer) and see if the coughing stops.
posted by rosethorn at 7:51 AM on June 21, 2011 [2 favorites]

Another voice to suggest checking for allergies. I had a similar cough for months that even codeine cough syrup couldn't touch, but Allegra cleared it up in a few days. Hay fever, in my case.
posted by moonmilk at 7:54 AM on June 21, 2011

Another vote for check for allergies. Also -- Years ago I went to an ENT for chronic stuffed sinuses and he did not even mention or deal with the allergies part -- I had to get that through a different path. In the end I found that allergy treatment helped me hugely.
posted by ClaudiaCenter at 8:34 AM on June 21, 2011

Has anyone x-rayed your head, or prescribed antibiotics? I had a cough for a year and it made my quality of life diminish dramatically. The doc-in-a-box didn't take me seriously in the least, and prescribed Tessalon "perles" which didn't to anything for my cough.

Eventually my year of hacking all night led me to ask a family member who was a doctor to please refer me for an x-ray, which showed infected sinuses full of goo. One course of antibiotics, a big bottle of codeine cough syrup, and I was good as new. I was so angry that I suffered for a year with this and the solution was so simple.

(for me. your mileage may vary and your cough may have nothing to do with a sinus infection.)
posted by pinky at 9:04 AM on June 21, 2011 [3 favorites]

GERD without obvious "heartburn" symptoms is definitely a possibility. It's important to sort out this possibility as it can lead to more serious health issues. There are very reliable tests that can establish this condition.
posted by nanojath at 9:29 AM on June 21, 2011

Allergist, then pulmonologist when you realize the allergist just wants to finance his boat.
posted by Ys at 9:59 AM on June 21, 2011

Oh, and I forgot to ask, how are your teeth? If you need dental work, it can seriously affect your sinuses. And vice versa - messed up sinuses can rot your teeth from above. One of those things that no one ever tells you.
posted by MexicanYenta at 10:43 AM on June 21, 2011

Your anemia makes me agree with pinky that you should first investigate the possibility of a chronic bacterial sinus infection.

All human pathogenic bacteria (with the exception of Lyme disease spirochetes, which apparently use manganese, interestingly) need a source of iron to grow, and this in turn can cause your body to sequester iron away from the bacteria, leading to anemia:

Systemic infection or inflammation causes a decrease in intestinal iron absorption and impairs the release of recycled iron from macrophages. Decreased availability of iron may deny this essential element to invading pathogens and may inhibit their multiplication and other metabolic processes but also results in anemia of chronic disease.

So if it is chronic bacterial infection and you get rid of it, you may get the bonus of curing your anemia.
posted by jamjam at 10:44 AM on June 21, 2011 [1 favorite]

This is for physicians, but you might want to keep it in mind when you see your new doctor (especially if you find yourself with another one that doesn't take your problem seriously): How should one investigate a chronic cough?
posted by Wordwoman at 11:12 AM on June 21, 2011

I would third cough-variant asthma; that what I have.

Also - if they decide that this is what you have, and/or they want to give you an inhaler, make sure they teach you how to use the inhaler! I first got diagnosed with this in college, was given an inhaler, but had no idea how to use it. Consequently, it didn't work. When I got diagnosed a second time, they taught me and that worked a lot better.
posted by spinifex23 at 11:28 AM on June 21, 2011

I get post-nasal drip that can lead to a cough when I am stressed out and/or eating too many carbs and sweets. Some food allergies or sensitivities can cause congestion and mucous production, which could lead to a runny nose and/or cough.

Any chance you have food allergies or sensitivities? I feel better when I cut back on sugar and refined carbs.

I would start by talking to your new doctor, seeing what he or she thinks, and requesting an x-ray of your sinuses to check. And an ENT specialist referral might be helpful, too. Good luck to you!
posted by shortyJBot at 11:55 AM on June 21, 2011

Go see an ENT; this is what they specialize in. I had very similar symptoms for over 6 months. Went to see an ENT, who put a flexible scope waaaaaaay up my nose into my sinuses. (He numbed me up first.) It took him 2 seconds to say "bad sinus infection" and prescribe pretty strong antibiotics for several weeks. Cleared it right up.
posted by ImproviseOrDie at 3:15 PM on June 21, 2011

ANy chance you have a down pillow or duvet? I didn't realize I was allergic to geese until I spent an entire winter hacking and snorking every morning. As it turns out, I was burying myself in my worst enemy every night. Just a thought.
posted by oohisay at 4:56 PM on June 21, 2011

I have a chronic cough, worse in winter or cold air, caused by inflammation. Menthol-Eucalyptus cough drops help a lot, and when it gets bad, I use a steroid inhaler. But, really, if your doctor doesn't take this seriously, you may want to look for new medical care.
posted by theora55 at 8:27 PM on June 21, 2011

Question about GERD. Is this likely when I don't ever have heartburn?

It's possible. I didn't have heartburn - I just felt a lump in my throat, all the time, and the post nasal drip. Sometimes referred to as 'silent GERD'.
posted by His thoughts were red thoughts at 9:39 PM on June 21, 2011

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