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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31326
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I am 48yof, 53, 160#, 31 year hx of smoking (quit 3 yrs ago).

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I am 48yof, 5'3, 160#, 31 year hx of smoking (quit 3 yrs ago). I have had a chronic cough for about 2 years. X-rays and CT are clear, bloodwork normal, lung function study within normal range, no other health problems. This cough comes and goes on a specific monthly basis with my cycle. I've been treated for GERD, COPD, allergies. Nothing is helping! Any suggestions?

Hello Eli,
I am Dr. Arun and will be helping you today.

Are you taking any blood pressure or heart medicine?
Are you on any supplement or herbs?

Customer: replied 3 years ago.

No blood pressure or heart meds. I take CoQ10, 5-HTP, mult vit, vit D. Lots of water and a reasonably healthy diet. No alcohol or drugs.

Hello Eli,

Were tests / investigations like endoscopy for GERD / Hiatal hernia performed?

Customer: replied 3 years ago.

No, and I've never had problems with heartburn.


Hello Eli,

Reflux laryngitis or laryngopharyngeal reflux or extraesophageal GERD, differs from traditional GERD in that it does not manifest as heartburn and tends to occur when the patient is upright as opposed to lying flat. This silent GERD can be present in as many as 80% of patients with chronic cough. The investigations to confirm it are;

1) Ambulatory 24-hour pharyngoesophageal pH monitoring
2) Barium esophagography
3) Laryngoscopy
4) Upper gastrointestinal endoscopy.

The common causes of chronic cough are postnasal drip (also called upper airway cough syndrome), asthma, and reflux laryngitis / gastroesophageal reflux disease (GERD). These causes are responsible for up to 90 percent of all cases of chronic cough. Less common causes include infections, medications, and chronic lung diseases. Another common cause of chronic cough is nonasthmatic eosinophilic bronchitis. Following causes are usually considered for the chronic cough;


1) Upper airway cough syndrome; they comprise of vasomotor rhinitis; acute nasopharyngitis; and sinusitis. The treatment is by steroid nasal spray or nasal antihistamine. Sinusitis may need antibiotic like trimethoprim-sulfamethoxazole or cefuroxime.


2) Cough variant asthma; this will require bronchodilator medications used in asthma or steroid inhalers. This in your case has been ruled out.


3) Reflux laryngitis and Gastroesophageal reflux disease (GERD); treatment is by avoidance of reflux-inducing foods (fatty foods, chocolate), eating five small meals a day without snacking, avoidance of meals for two to three hours before lying down (except for medications), elevation of the head of the bed and an H2 antagonist or a proton pump inhibitor.


4) Postnasal drip; would need antihistamines and inhaled ipratropium bromide.


5) Non specific cough; Dextromethorphan and/or codeine can be used.


In your case, Upper airway cough syndrome (UACS), previously referred to as postnasal drip syndrome (PNDS) should be ruled out. PNDS refers to the sensation of secretions from the nose or sinuses that drain into the pharynx in addition to nasal discharge and frequent throat clearing. Unfortunately, this is largely based on patients’ subjective symptoms, which frequently do not show any significant physical examination findings. Almost 40% of patients with PNDS-induced cough are unaware of the presence of postnasal drip or its link to their cough.

Also stop CoQ10, 5-HTP, for a month or more, which rarely may cause cough as a side effect.

Anxiety associated with the history of smoking may augment reflux laryngitis and thus may be a contributory factor.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.


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Customer: replied 3 years ago.

Also, more recently, when I have a bad coughing fit, I get a sudden severe headache at the back of my head.

Hello Eli,

The headache can be due to two reasons.

1) A sinusitis which causes cough and headache.
2) The strained muscles of neck due to coughing too can be responsible for the headache.

It is privilege assisting you.

Dr. Arun
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