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Doctors' Answers to "Frequently Asked Questions" - Coughing

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Cough or Allergy [posted 12/08/98]
Question: I have had a cough for about 15 years, I have been on blood pressure medicine for 3 years. I have went to the doctor about the cough because it gets real frustrating sometimes when you cough everyday, anyway I was told that it was probably from the blood pressure medicine. I am thinking more in terms of possible allergies. Is there anything I can take over the counter and would not make me drowsy?

Answer: Change your BP meds first. There are several which work fine and won't cause a cough. Then work on the allergies if still present.

Severe Cough [posted 11/25/98]
Question: I have had a severe cough for about three months, going from one cough prescription to another, using 2 different inhalers, a nebulizer, and prescription allergy medicine,this coughing spasm usually is much worse at night, causing lack of restful sleep, I am awake usually 2-3 times nightly, sweating and difficulty breathing. I'm at wits end with this problem, and am desperate for some answers. My doctor now wants me to start allergy tests, do you think this may help?

Answer: The three usual causes of refractory cough are 1) post nasal drip 2) reflux of gastric material into the lung at night 3) Cough variant asthma(when one coughs instead of wheezes) or 4)any combination of the above. These diagnosis will diagnose 90%plus of coughs. So, try nasal steroid spray plus/minus atrovent nasal; ensure you don't have reflux(usually a drug like Zantac etc) and finally convince your doctor to treat you for asthma with inhalers and occasionally steroids. If you can identify one of the causes that is predominant, focus on that one. Allergy desensitization would only be of effect in post nasal drip and the nasal steroids will work lots faster.

Chronic Cough [posted 8/13/98]
Question: My mom seems to have a problem with chronic cough or asthma - whichever it may be. She is taking cozaar and lozal to bring her blood pressure down. Can these drugs cause coughing side effects? If so, to which drug could she change to, to keep her blood pressure down. She is now on an inhaler dilade, which at times, uses once to twice a day. This seems to become a critical problem and we are searching for answers.

Answer: Cozaar usually doesn't produce a cough. Lozal is a form of indapamide which is a diuretic similar to other thiazide diuretics. Neither of these drugs is known for exacerbating cough, but anything is possible. I'd discuss it with her doctor and see if selective stopping is an option.

Severe Coughing and Medications [posted 7/23/98]
Question: I am a chronic hypertension patient with an ongoing pressure of about 200/100, and sometimes the diastolic is higher.
I am currently taking the combination of drugs:
I would like to know if these or any of these medicines could cause severe coughing spasms. I have been having them for about 2 or 3 weeks and I am so bad off that I almost lose consciousness and my face turns blood red and my eyes and some kind of weird foam pours out of me by the cupfuls and almost strangles me. This is the most frightening thing that I have ever experienced.. What is going on with this constant cough? Could it be a sign of something? When this happens I become so weak that I have to go to bed, no matter where I am. I am afraid this is very debilitating and I am a very physical person. I recently had some kind of strange stomach virus, and after the diarrhea ceased, then this started. I am afraid it is going to kill me. Can you offer a possible explanation for this? Have you ever heard of something like this? Could it be my medications?

Answer: Prinivil is notorious for causing a cough. You may substitute Cozaar or equivalent medication. The others would rarely cause cough.

Spreading Germs from Coughing
Question: How far can germs from coughs travel and how long can they stay in the air? Also could you provide other information related to people not covering their mouths, and germs being transmitted via coughs.

Answer: Bacteria and viruses from oral secretions can be easily spread by coughing. In general, this is about 6-8 feet, although occasionally a powerful cough has been documented to spread aerosolized spray to 20-24 feet. These organisms slowly drift to the floor or other surface depending on gravity, the size of the vapor droplet and prevailing air currents. They can stay suspended for several hours. The ability of these droplets to transmit disease depends on the temperature of the air, the ability of the bacteria or virus to survive out of the body and the virulence of the particular infectious product. Most bacteria and viruses don't do well when they are dried out. Consequently, they depend on some moisture. Tenacious viruses can exist for several days as aerosolized droplets.

Question: I have had a unproductive cough since August of 1995. It originally started as Bronchitis (which was so severe I cracked a rib). The Bronchitis went away after two different treatments with antibiotics, however I was left with a cough that only appeared if I bent my head to look down or if I laughed. I have been tested for reflux-normal, and I had an Upper GI Series-normal. I also do not suffer from shortness of breath or any other breathing difficulties. My physician not know the reason for my cough and suggested in November that it was just taking longer to recover from the Bronchitis. However, he did not do a sputum test or throat culture which I feel is a pretty basic test and would tell him a great deal about my cough's source.

Answer: Common causes of persistent cough are 1. Post-nasal drip. 2. Cough variant asthma. 3. Reflux esophagitis with mild aspiration of acid/food. My approach to this problem is to either treat the post-nasal drip, possible asthma, and reflux. You should focus on any symptoms of these diseases. For example, a childhood or family history of asthma may be the clue--this is a common problem following a respiratory illness. The infection can trigger “spasm” of the lung passages and instead of wheezing some people cough.

Chronic coughing after lung surgery for cancer
Question: My father inlaw had a lung removed from cancer caused by asbestos at a hospital in august of 1996. He developed a steady cough which has not gone away. The doctor who performed the surgery had checked his throat and lungs and could not find any problems. He has had radiation for 6 weeks following the surgery. He cannot sleep and is not eating good. He has phlegm when he coughs and just recently starting to get a foul smell when he coughs. He is very weak and sleeps a lot. We would like to find out what he can do for medications or nutrition, herbs, etc, to end this coughing.

Answer: What does his physician say is the problem? It sounds like he has an infection - what with the smell and all. Cough can be due to repeated reflux and acid from the stomach entering the lung at night, spasm of the pulmonary tree - like mild asthma, and chronic post-nasal drip. However, if he didn't have the cough before surgery something is not right. Herbs, etc. won't help, but I doubt that they will be the whole answer.

Cough Suppressants
Question: This past winter I had a cough that was not treated by over the counter medications and was treated with water, humidifier, etc. It seemed to get worse at night and started to keep me up as I was coughing more at night. I attributed it to having prior drainage and coughing to get it all up. This is the first time I have ever had a problem at night (I am 34 and in excellent health). I was given a prescription for hycodan which worked pretty well but did give me a headache. I was concerned about using a narcotic as I have a diabetic three year old and check his blood sugar in the middle of the night and was concerned I couldn't get up or would be to groggy to take action. I didn't have that effect nor the effect of being "high"...side effects were being tired and a headache. The hycodan was 5 mg My mom had a similar problem and was given guiatuss ac syrup and She had no side effects. since they both have codeine in it, are they technically the same? How come one gave me certain side effects and not other side effects. What is the difference of codeine vs hycodan? In your opinion is one better than the other?

Answer: Codeine is an opioid narcotic as is hydrocodone(dihydrocodeinone). Codeine can be given either IM(intramuscular) or PO(oral). Hydrocodone can only be given orally. The duration of action is similar - about 5 hours. Hydrocodone has a slightly longer plasma half-life. From a practical point of view they are nearly equivalent. Next time try any cough medicine with dextromethorphan. This is the “d” isomer of levorphanol(a narcotic similar to codeine)but has no analgesic or addictive properties. It seems to act centrally to change the threshold of coughing and is equivalent to codeine in controlled studies. It generally has fewer side effects, especially sedation and constipation. You will need 10-30 mg 5-6 times per day and check the doses on the medications because they often underdose the drug.

Persistant Cough
Question: About two weeks ago I developed a pretty bad cough. Since I do usually get a cold at the beginning of winter I didn't worry too much but now it seems that the cold is turning into something else, I have a sore (but apparently not infected ) throat, I have to cough a lot and very intensively - up to a point of feeling like having to throw up. Lately I've found it difficult to breathe, especially in the morning and right after coughing. The phlegm that I bring up is clear and kind of thick. My lungs seem to be fine - no noise. A humidifier seems to help a bit, but I still sometimes feel that I'm suffocating, I wake up at night because I turned or stretched - every major movement seems to set off my cough. I'm a teacher so I have to speak a lot, and I have recently moved from the German Baltic Sea coast to Iowa (dry air, air conditioning everywhere). I have never had asthma, croup or TB (recent test negative).

Answer: Coughs come in two varieties-acute and chronic. Coughs can be caused by four basic stimuli. That is chemical, infectious, mechanical, and thermal. Chemical stimuli are different environmental factors such as perfumes, cigarette smoke etc. Infectious have to do with the inflammation of the lung during and after infection. Mechanical is the cough caused by stimuli such as chalk particles, lung tumors, etc. Thermal is a cough caused by either cold or hot air. With the phlegm, yours sounds infectious or inflammatory. However, teachers are notorious for having coughs caused by chalk dust. I'd give your physician a call and see if you have a persistent infectious bronchitis-if treatment doesn't work then you'll need to isolate the other factors.

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