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My 91 year old mom has a cough for about three weeks. Took…

Customer Question
My 91 year old...

My 91 year old mom has a cough for about three weeks. Took him

Doctor's Assistant: How long have you been dealing with the cough? Are you having any other symptoms?

Two weeks sour through . She was seen by care dismissed it as hey faver what can we do about cough. Over the counter seam to help, trying to get her in to her primary Dr. Help

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

Her breathing is fine 92 ox BP is 127/ 72 just the cough

Submitted: 7 months ago.Category: Medical
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Answered in 3 minutes by:
11/25/2017
Doctor: Dr. Arun Phophalia, Doctor replied 7 months ago
Dr. Arun Phophalia
Category: Medical
Satisfied Customers: 38,775
Experience: MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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Welcome to Just Answer.
Answers here are for education and information.
I will respond shortly with an answer, or further information request.

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Doctor: Dr. Arun Phophalia, Doctor replied 7 months ago

In her age group, cough of 3 weeks would need following investigations;

1) Chest x-ray

2) Blood counts.

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.

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.

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Customer reply replied 7 months ago
Thanks
Doctor: Dr. Arun Phophalia, Doctor replied 7 months ago

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Doctor: Dr. Arun Phophalia, Doctor replied 7 months ago

The diagnostic and management protocol for the chronic cough is as following;

1) we will do a chest x-ray first.

2) pulmonary function tests or spirometry is the second step

3) starting of empiric therapy for postnasal drip, asthma, or gastroesophageal reflux. The GERD can be sometimes uncontrolled despite the medications and this will need further evaluation in the form of esophageal manometry (food pipe pressure study) and pH study of the food pipe (esophagus).

4) methacholine challenge testing to evaluate for airway hyperreactivity; done for the bronchospasm / bronchial asthma.

5) sputum or phlegm examination for eosinophils or empiric trial of corticosteroids for eosinophilic bronchitis.

If despite these measures, cough persists we would consider further investigations like esophagoscopy, 24-hour pH probe monitoring, high-resolution chest CT, or bronchoscopy.

The chronic cough has usually three origins; a) Chronic sinusitis b) Upper respiratory tract; chronic bronchitis c) Lungs; infections, chronic obstructive pulmonary disease or restrictive lung diseases are the main causes. Specialist to see is pulmonologist. Following investigations should be done, if not already been done; 1) Pulmonary function tests 2) CT scan of sinuses 3) HRCT of the chest Atypical infections like mycobacterium should be seen in her age. The usual cough culture do not give positive results for these bacteria and special cultures are needed for them. Chronic bronchitis and Bronchial asthma are the other common causes. Usually they have allergic origins. Immunoglobulins IgE, total eosinophil counts and vacuolated eosinophil counts point towards allergic phenomenon. They are treated for by inhalation steroids. A consideration of bronchodilators and corticosteroids through nebulizer should also be done. With the above measures, breathing exercises, and chest physical therapy should be beneficial to her. One very common cause for the cough is gastroesophageal reflux disease in her age group. This should be considered, if respiratory tract seems to be not involved. Investigations like 24 hours pH estimation, esophageal manometry and upper gastrointestinal endoscopy would be contemplated.Just Answer is based on honor system. Experts are paid for time and expertise only when a positive rating is received.Best wishes,It was my pleasure to help you.
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Doctor: Dr. Arun Phophalia, Doctor replied 7 months ago

A positive rating would be highly appreciated if it was helpful to you.

Best,

Happy Holiday season.

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