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So, my Chronic Cough is back. I've been coughing for about 2 months now. It is extremely unpleasant. I cough throughout the day and have developed a lot of sore muscles and ribs and some bladder issues from it. When I have coughing attacks, the coughing is so bad that I end up heaving and sometimes vomiting. This happens a lot in the mornings when it lasts from about 1-3 hours before I can even think about leaving for work. I end up bringing up my meds a couple times a week too. :confused:

We had some nasty air set in last December that triggered my coughing. It has pretty much been a constant until yesterday--Worn my 'Darth Vader' face mask all winter. While I know it is a major influence, all of the doctors have agreed it isn't my only problem.

Causes of Chronic Cough:

*Asthma: I'm on Dulera a couple times a day, Singular, Albuterol as needed (Puffer or Nebulizer), Xolair shots monthly, and I've done a round of Prednisone. Ironically, my lungs don't actually sound too horrible lately.

*Allergies/PND: I'm 6 years into immunotherapy and not currently on any allergy meds. I am on Promethazine DM or Promethazine with Codeine which do have antihistamine properties. I saw my ENT and had a scope last week. My throat is red and there is a bit of mucous, but no signs of allergy or PND.

*Acid Reflux: I had a Nissen Fundoplication 5 years ago. I take Dulera daily and supplement with OTC meds. I spent a couple weeks in December taking Dulera twice a day and really didn't see much difference. I started on them twice a day again yesterday. I had a good Endoscopy last fall and had pH testing on Dulera then as well. The testing indicates my acid reflux is controlled on the medications. I do sleep on an incline too.

Conclusions:

My PCP has tried several meds with me that haven't worked. He gave me the cough syrups and Prednisone. My last visit, he told me we had done everything he had to offer since I was already doing so many things to address the problem.

My ENT/Allergist Put me on Levaquin since I'd already tried so many things and there was a bit of redness and mucous in the scope. I'm a week out on it with no difference so far. He was nice enough to bump the Promethazine scipt from DM to Codeine. He indicated I have a reactive airway happening. He basically told me that I was already doing so many of the right things already. He did have me get a chest x-ray which is good.

My Gastroenterologist yesterday went through everything I've tried and reviewed all the testing I've had. He did recommend being more aggressive in treating my IBS with medications, even when I'm feeling OK, because it can through off my balance. He also thinks I may have more non-acid reflux influencing my cough, but I'm already on all the treatments they would recommend for that. He told me that I was a 'unique' patient who doesn't respond to treatment like others do. Translation to me: he doesn't really know what else to recommend either.

I have a lot of trouble getting appointments with my Pulmonologist. I scheduled one last August and it isn't for a few more weeks. They haven't had any cancellations either. I'll have some PFT's prior. At this point, I'm not sure what he will be able to offer me though.

I've had Pertussis before and this doesn't feel the same.

At this point, I'm miserable, but have no idea what else to try. I have coughing fits throughout the day and spend many mornings coughing/heaving and trying to catch my breath.

I'd love to hear from anyone who has something to offer.

Thanks for listening.
MR
Hi,

Yes. I do take my peak flow regularly. Thankfully, I've been hanging out around 300. My normal is 425. My Pulmonologist wants me below 250 for Prednisone. I tried it anyway after a couple months of this. It just didn't kick it.

Unfortunately, I seem to have had a reaction to the Levaquin. That has never happened before. Now, I'm dealing with probably tendon pain in multiple areas of my body. My docs don't really know what to do other than stop the Levaquin. Which I did. They put me on a different antibiotic, just in case there is something bacterial going on. I'm waiting on some bloodwork as they rule out the reasons for my sudden inflammation. Other than that, I've seen 2 docs and they have nothing to offer for the pain which I've now had for 6 days.:( It is almost worse than dealing with the cough.

I thought the cough might be getting a smidge better yesterday. Then, I had 3 people at work tell me I sounded worse. Sometimes, I just feel that you can't win. Still fighting though.
Mountain Reader I feel your pain. I've had cough variant asthma for about 5 years and so have the same chronic cough. My asthma is nasal in origin with severe post nasal drip. I have tried all the meds that you have mentioned and I have had the best success with momethasone (asthmanex) in combination with symbicort 2 puffs each morning and evening. I also take flunisolide nasal spray twice a day.
Whenever I get severe coughing attacks my md gives me one or two rounds of prednisone regardless of my peak flow.
Best of luck to you. I'll keep you in my thoughts and prayers.
An ACE level as high as yours would make me highly suspect sarcoidosis, which causes chronic cough, arthritis, and is treated with Prednisone. It is not very common, but a pulmonologist and rheumatologist should get their heads together on ruling that out. There are also pneumonitis issues associated with lupus, which the ANA test can be positive in, but also + in other conditions. Your ACE level is off the charts, IMO, and that should be primarily considered (sarcoidosis). A bronchoscopy with biopsy should be considered to diagnosis this, and I would highly recommend you get into National Jewish Hospital in Denver for evaluation if your local Drs can't figure this out.
Thanks Ladybud. You give good advice.

I had a Neurologist who referred me to my Pulmonologist because he was concerned about the ACE. My Pulmonologist said any treatments he could provide for Sarcoidosis would be worse than any symptoms I currently have. He even went through each of the standard treatment meds and the side effects of them compared to my current symptoms. I had a PCP refer me for a chest CT a few years ago because he suspected Sarcoidosis and it came back normal at the time. That was before my ACE testing though.

My Pulmonologist has been reluctant to do the bronchoscopy because of how invasive it is. He has wanted to focus on the GI stuff first. I should probably bring it back up in discussion at my next appointment.

Both my Pulmonologist and PCP have said that some people just have a naturally high ACE. I can't find anything on that on the internet.

I do go back to my Pulmonologist at the end of the month.

I'd love to go to National Jewish Hospital for this to see if they could find something new for me to try. I even e-mailed back and forth with them a couple years ago. I just can't figure out a way to pay for it though. My insurance is OK, but it isn't that good.

I found an editorial cartoon that really spoke to me in February. The patient is standing there coughing. An ENT, Pulmonologist, and GI doc are all standing around with question marks over their heads. That picture could have been me. All of those docs are on my team and I still don't have those answers. They each just treat their piece of things.

I forgot to mention. I have issues with Prednisone above 20 mg at a time. Sometimes I can handle 40 mg. for a short period of a couple days. Anything over that and I have some bad side effects. My Pulmonologist has me avoiding it unless absolutely necessary.
My Neurologist was concerned about the high ACE and sent me back to my Pulmonologist. He said Sarc is a possibility but that the steroids would be worse for me now. I really don't react well to being on Prednisone very long. My ENT and PCP both said with a score like that and a clear CT that I may just have a naturally high ACE. I haven't been able to find anything on that on the internet though.

They agree the ANA indicates something, but none of them knew what because I haven't had enough symptoms to be categorized for a diagnosis.

I am having chest x-rays a couple times a year. They all show clear too.

I'll bring this up again at my Pulm appt. Monday, but unfortunately I'm not holding out much hope.

I would love to visit National Jewish, but I can't imagine coming up with the funds. I've had 2 surgeries in the last 6 months that I'm trying to pay off already. I seriously think I have a connective tissue disorder. My joints keep going one at a time. Asthma and the digestive stuff can both be connected back to it. I've brought it up with several docs and they say there isn't a doc in the area to do a formal diagnosis. My GI doc strongly thinks I have EDS though.





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