Chronic cough

[ed9]

Started coughing about 5 years ago. First a little esp after exercise and then more and more. Coughing would continue until I expelled phlegm which was light color. At night coughing could be initiated by changing sleep positions and more phlegm. Wheezing common but constant cough is the worse. Continue to feel that I have to expel. Allergist checked for allergies found none, respirologist scoped lungs and were ok, biopsy ok also. Rescue inhalers and steroidal inhalers(Symbicort,Zenhale, Nasonex) did not show improvement. I've had three chest xrays and one showed some pneumonia and antibiotics helped the first time and conditions greatly improved and then returned in a few months. Tests include exercise stress test, CT of sinuses, breathing test with asthma irritants and ecg. Tests showed nothing that lead to improved treatment. My heart and lungs seem to be ok.
Worst part is the constant coughing, hundreds of coughs/day leading to fatigue, aching ribs and sweating from the action of coughing and lost sleep.
Then in August a gradual improvement and I found that I could start taking deeper breathes and laugh more without coughing(usually laughing led to coughing). Continued to improve and I thought that I was cured, very happy. No change in treatment(was on Zenhale at the time but inhalers over the years made little if any difference). Cough started ti come back a little early December and got worse, until I am back to frequent coughing and spitting up phlegm. No seasonality to coughing. Sorry for the lengthy description but I find it difficult to function and thought giving as much info as possible would help..thanks ed

[ed9]

Thank you Dr.Mathur for your response. I had a six month treatment with ppi and some antacids with little improvement but I am not aware if any of the tests you suggested were done. I will ask to have these done and find the results. My cough can happen at any time, on occasion I can be at my desk and all of a suden start coughing for a minute or two all the while trying to cough something up. Once I do it feels better but can quickly come back. Exercise  triggers coughing but I may be able to workout for 15-30 minutes before and then when done start to cough. Again, I cough hard until something comes up and then less so...also laughing makes me cough...ed

[Dr. Kokil Mathur]

Hi!
I am sorry to hear about your medical problems. Since the cough comes when you change position while lying down, and all other causes are ruled out, In all probability, you are suffering from a bad gastric reflux.
Treatment is a combination of drugs to reduce the acid and lifestyle changes. You will need to take a combination of medications (under medical supervision) like a proton pump inhibitor such as omeprazole, lansoprazole or pantoprazole empty stomach in the morning and an antacid gel after meals or H-2 blocker such as ranitidine for complete relief. Possibility of H pylori infection too should be looked into by a carbon urea breath test and a combination antibiotic tried. Many a times a persisting H pylori infection can be the cause behind acidity not responding to treatment. This can be diagnosed through blood test, carbon urea breath test and endoscopy.
Life style changes that will help include: Drink cold milk at night or take a late night snack. Avoid heavy meals and eat frequent small meals. Avoid too much of caffeine, tea, smoking, fried food and drinks both alcoholic and non alcoholic fuzzy ones. Avoid heavy exercises within 4 hours of a heavy meal. Raise the head end of the bed by pillows to 30 degrees. Avoid lying down for least 2 hours after food. Maybe these tips will help you.
Please consult your doctor regarding this. Take care!

The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.