CHRONIC COUGH
Q I have had cough for the last several months. It is mostly dry and worse at night ?
A Most cough and cold like symptoms are due to upper respiratory viral infections and
bronchitis and they resolve in seven to 10 days. But cough persisiting more than six weeks
is chronic cough and it requires further evaluation.
Chronic cough can be caused by problems in your nose, sinuses, throat, lungs, heart or food
pipe. Often patiens take a variety of medications to alleviate the cough withoug addressing
the underlying problem and therefore not see adequate relief. The successful treatment of
chronic cough depends on the proper identification of the underlying cause and it's
treatment.
Post nasal drip, throat clearing, stuffiness, foul breath or headaches and pressure on the
face may indicate sinus infection while itchy nose, eyes, throat and clear runny nose would
indicate allergies.
Waking up at night coughing would indicate asthma and or gastroesophageal reflux. ( GERD
). Wheezing, chest tightness would indicate asthma while indigestion and heart burn would
indicate GERD. Swelling of the feet, eye lids and history of heart problem or blood
pressure would indicate heart disease. Some patiens may have more than one factor
contributing to the symptoms. Unwanted weight loss and or fever would indicate a more
serious disease.
Detailed hsitory followed by physical examination would be followed by testing which would
include but not limited to allergy testing, pulmonary function testing, sinus and chest Xrays.
Some patients may need CT scans of sinuses or chest and evaluation for GERD. All
patients do not require all of these tests. Once the diagnosis is confirmed treatment can be
started.
SINUSITIS
Q I have had pain and pressure on my sinuses and my doctor has treated me with
antibiotics. I get better although not recover completely only to get worse again after few
weeks ?
A Seems like you have what is called either a Chronic Rhinosinusitis or Acute Recurrent
Sinusitis. A fairly common condition especially in people who also have allergies. This
condition results from the inflammation of the nasal passages and paranasal sinuses, the air
filled cavities surrounding the nose. Inflammation may develop due to exposure to
environemntal allergy causing substances, smoke or other irritants. Later on bacterial
infection may develop further complicating the disease process. Chronic sinusitis results into
11 million doctor office visits annually and approximately 32 million American suffer from
this condition. So you are not alone.
Common symptoms include facial pain or pressure, facial and nasal congestion, Nasasl
discharge which may be clear or discolored, headache, bad breath, fatigue, dental pain and
a very important symptom which is often overlooke and that is Chronic Cough. Lot of
patients may have only nasal congestion without any other symptoms.
Proper evaluationwill include a physical examination followed by either a plain X-Ray or a CT
scan of teh sinuses. Most patients require allergy evaluation to look for any allergic factors
contributing to the development and persisitence of the symptoms.
Treatment would include Nasal Irrigation with salt water solution, oral decongestants,
Antibiotics and in some cases a short course of steroids especially inthose patients who have
severe acute discomfort. Nasas sprays containing decongestants may not be used for more
than three days. It is very important to look for the factors contributing to the development
and persistence of sinus problems.
ASTHMA ALLERGIC OR NON ALLERGIC
Q I have sinus problems and asthma off and on. Could allergies be causing my asthma
?
A Allergies are an important cause of asthma. In infants and toddlers infections may
also be an important cause of asthma flare ups. In preschoolers, school age children and
teenagers as well as young adults allergies may play a role in causing or aggravating
asthma symptoms. In older adults although allergies are less likely but they still play a
significant role in many patients.
Most people think allergies are something that makes you sneeze or cause itchy runny nose
and eyes. They think of allergies if they have symptoms during a certain season. But what
most people do not realize that you should also suspect allergies if you have constant stuffy
nose, post nasal drip, sniffling, sinus pressure along with asthma. Even if you do not have
hay fever symptoms to suggest you have allergies, your asthma could still be due to
allergies. Even if you do not notice worsening of your asthma symptoms with exposure to
cats or dogs or dusting and vacuuming your house, you may still be allergic to cats, dogs
or dust mites. In patients with chronic asthma and who are allergic to multiple things a
clearly noticeable flareup in asthma is not seen when they come in contact with what they
are allergic to.
Why is it important to know if you have allergic asthma ? Identification of an allergen can
result in appropriate actions being taken such as removal of feather pillow/ comforter or
pets or old carpet. covering the mattress and pillow with dust proof cover, removing
stuffed toys and staying in air conditioning are some of the things one can do.
Even if you can not find a connection in asthma and allergies a thorough evaluation can be
helpful. Management of sinus infection and gastro-esophageal reflux can make asthma
treatment easier in an individual information.
