Tuesday, August 14, 2007

Never-ending coughs

As the new school year approaches, I face once again the prospect of being shut up in an exam room with someone in thin control of thick secretions. There are days during the cold and flu season where I feel like shouting into the waiting room "Go home, there is nothing I can do for you. Pick up a prescription for codeine cough syrup from the receptionist and call me in two weeks if it hasn't gone away."

Now, courtesy of The American College of Chest Physicians, there's a whole new lexicon in cough diagnoses. No more 'cough due to post nasal drip' as in the gunk slipping down the back of your throat is making you cough. Upper airway cough syndrome sounds more worthy of that pricey visit co-pay anyway, and the new name recognizes that it's not just about the mucous stuck in your throat anymore but also about inflammation of the cough receptors in the upper airway.

What about the never-ending coughs from hell following chest colds? These coughs last more than 2 months here in Denver where the air is dry and filled with dust and automotive schmutz through the winter months. These coughs are now called post-infectious cough secondary to upper airway cough syndrome.

While the chest docs recommend treatment with an antihistamine-decongestant combination drug, I prefer prescription Tessalon Perles (generically available as bezonatate) which specifically quiets those unhappy cough receptors. The new guidelines also tap an inhaler called Atrovent (ipratropium) as useful for post-infectious coughs.


Mauigirl said...

The possibility of contagion is one reason I never actually decided to try to become a doctor. I love trying to diagnose illnesses from a distance (Tell me your symptoms, I'll try to guess what's wrong with you) but I never wanted to be in a room with someone hacking all over me. Especially since half the time it's a virus and nothing I could do for them would really help.

I commend you for exposing yourself to everyone's illnesses!

Speaking of coughs, I've always wondered why ACE inhibitors give some people (such as myself) that annoying tickly cough? Does it stimulate the cough receptors?

Elaine said...

I am so dreading ragweed season about to begin, I can tell a difference already with the "stuff" getting caught in my throat. Do you order kenalog injections for your chronic allergy patients? I get one about once a season and it seems to help. I see my PCP next month for routine maintenance :-) might be a good time to ask for one of those magic shots.

PalMD said...

I've seen a disturbing number of pertussis cases as well.

Femail doc said...

MG: I don't know why ACEIs cause a cough either, but it's a shame as they are such a good class of drugs, directly promoting healthy blood vessel function independent of any blood pressure benefits. I find, at times, that patients will tolerate ACEIs for years, then get a chest cold with a cough that persists for months and finally goes away when the ACEI is discontinued.

Elaine: The ragweed season is definitely underway here in Denver. Lot of hacking and spitting here which is difficult to distinguish from a cold and often seems to bring on a sinus infection. I've never tried the kenalog injections, but I know a lot of people seem to benefit from them.

Femail doc said...

Palmd: I think a lot more people think they have pertussis than actually have it. I tell the ones who wonder aloud whether they've got pertussis but cough not at all during the visit that they probably do not have it. And we're just about to enter the season where everyone thinks they have flu and want Tamiflu.

Caitlin said...

Looks like you wrote this post a while ago...but thought it was kinda relevant to me. I'm a med student and we learnt this year about ACEI's - they cause a cough due to the fact that in addition to blocking conversion of angiotensin I to angiotensin II, they block the degradation of bradykinin, a vasodilator (bradykinin has a similar action to histamine, apparently, causing the cough)...a little bit of trivia.
I was also unlucky enough to contract whooping cough this year, and believe me, I was surprised when I got those test results. It left me with a 7 month cough...i've tried everything and now I'm on atrovent. Can't tell if it works but it doesn't do any harm! They described it as a post-infectious cough...

femail doc said...

Well thank you Caitlin. I never knew why ACEIs did that cough thing. I appreciate your pearl.