cough
August 14, 2010 | 10,00 EUR | answered by Dr. med. Olaf Stephan
Hello,
For the past 6 months, I have had a persistent cough that won't go away. In addition, I have a strange sensation in the solar plexus area and a constant scratching in the thyroid area, which mixes with a cough reflex.
The following tests have been conducted:
ECG
Stress ECG
24-hour ECG
24-hour blood pressure monitoring
Heart ultrasound
Blood tests with sometimes slightly elevated inflammation levels
Lung function test
Chest X-ray
Pertussis serology
Helicobacter serology
EBV serology
Allergy test
Gastroscopy
All tests came back inconclusive, so I am told that I am healthy. The only finding was that I have tachycardia and now have to take Metoprolol. However, I do not believe it could be psychological, as I feel sick every day. Sometimes I wake up in the morning feeling really unwell, as if the body is doing something or fighting against something during the night.
The cough is relentless and I am physically exhausted.
What else could it be?
Dear inquirer,
yes, a persistent cough can indeed be a significant burden for the individual affected and is often difficult to influence therapeutically, as such a long-lasting cough often becomes a conditioned reflex. The constant coughing leads to inflammation of the mucous membrane in the trachea and bronchi, which in turn triggers a new cough reflex. First and foremost, the cause of the cough should be determined, if possible, and it seems that you have already undergone many tests in this regard. The cause of the cough is often related to the onset of asthma, which can be detected through lung function tests. Additionally, an allergy (often to dust mites) could be the cause, which can be determined through allergological testing. It should also be clarified whether there is exposure to dust or pollutants (e.g. through work). If you are a smoker, you should quit, and there are various medical options to help with this. Furthermore, an ENT examination is necessary, as there may be a chronic inflammation of the larynx or similar issues. In the case of a long-standing cough, an endoscopic examination of the trachea and large bronchi (bronchoscopy) is also necessary. This examination is performed on an outpatient basis by pulmonary specialists. These are the tests that are still pending and could potentially provide a diagnostic clarification. Additionally, the cough could also be drug-induced, often by ACE inhibitors (medications for high blood pressure), whereas beta-blockers do not have this side effect (but they could worsen pre-existing asthma!). As a treatment, cough suppressant medications should be given regularly (e.g. codeine), but not ACC, ambroxol, or bromhexine (as these only intensify the cough reflex). It is also advisable to use an effective corticosteroid inhaler regularly to treat inflammation in the bronchi. Currently, the best available preparation is the Flutide inhaler, which should be inhaled twice daily. The treatment can begin even without knowing the exact cause of the cough, so that you can experience relief. It is best to have your primary care doctor refer you to a specialist in pulmonology, who can conduct the necessary diagnostics and prescribe the medications. I hope that I could help you with your problem. Best regards, O. Stephan.
