That annoying and persistent cough (Part 2)

Q: I’ve had a cough for over three months. I took three different antibiotics and every cough mixture in the pharmacy, but it persists. What could be causing it and how do I get rid of it?

In last Friday’s edition of the Searchlight, Part 1 covered the causes and complications.

Determining Cause

This starts with the doctor taking a thorough medical history and performing a physical examination. For quite often, such can provide important indicators as to the actual cause. At this stage the doctor may recommend a form of treatment that is not only aimed at getting rid of the cough, but by extension will confirm the suspected diagnosis. In certain instances, your doctor may request tests in order to help with determining what may be causing the chronic cough.

Radiological Imaging

X-rays of the chest and or sinuses: A chest x-ray would not identify the most common reasons for a chronic cough, however, it is often useful when checking for pneumonia, COPD and lung cancer. Sinus x-rays may help with diagnosing sinus inflammation.

CT Scans of chest and or sinuses: These are more sensitive than routine chest x-rays at diagnosing (early) lung cancers and sinus infections.

Pulmonary function tests

Spirometer: This is a simple, non-invasive test, which is very helpful in diagnosing asthma and COPD.

Lab tests
If the mucus is discoloured a sample may be sent for culture.

Scoping (where available)

These are tests of last resort when the initial investigations don’t reveal anything definitive:

Bronchoscopy: A thin flexible scope is inserted through the mouth, down the airways, into the lungs.

Rhinoscopy. This scope is inserted through the nostrils in order to visualize the nasal passageways, sinuses and upper pharynx.

Treatments for chronic cough
Treatment will depend on the cause of the cough:

Postnasal drip
A combination of antihistamines, steroid nasal sprays and decongestants are often used in treating allergies and postnasal drip.

Acid reflux
When dietary changes and lifestyle modifications don’t control acid reflux, medicines are often prescribed to significantly reduce the stomach’s acid secretions.

Asthma
It has been found that inhaled asthma drugs, specifically bronchodilators and corticosteroids, help to reverse the airway narrowing in asthma.

COPD
This is treated with inhaled bronchodilators and inhaled steroids.

Infections
If a bacterial infection is suspected as causing your chronic cough, your doctor may prescribe a course of antibiotics.

Smoking
Smokers with a chronic cough should immediately quit smoking.

ACE Inhibitor
If the chronic cough is due to the use of an ACE inhibitor, your doctor will likely switch a different type of blood pressure medication.

Additional ways to manage a chronic cough (in adults).

To suppress coughing, cough mixtures/ medicines with any of the following ingredients may be used:

• Dextromethorphan (DM)
• Benzonatate
• Codeine or hydrocodone (these are potentially addictive)
• Gabapentin

See your doctor for your chronic cough if:

• Coughing up blood or discoloured sputum.
• Wheezing or shortness of breath is present.
• Running a fever.
• Losing weight.
• Having drenching overnight sweats interfering with your quality of life.
• Smoker over the age of 45.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.