Nagging Cough
Who of you hasn’t found it
more difficult to shake a cold these days?
Chances are each of us has been left with a
cough that simply won’t quit. Try as we will
to be patient, tolerance is not a quality we
have in large supply. It’s another of the
simple hassles that turn into a nasty mind
occupying obsession.
A tincture of time
followed by Tylenol, aspirins, cough
medications, gargles, vitamins, supplements,
antihistamines, decongestants, left over
antibiotics, never seem to work as cued.
Desperation leads to grandma’s favorite
tonics, and home remedies. Too often one
seems to obtain initial improvement only to
be followed with a disheartening relapse.
Out of a sense of personal
failure one is left to seek out a doctor.
Now the able physician
doesn’t pass it off as an inconsequential
issue despite seeing how well you seem to be
otherwise. He is well aware how exasperating
it is to you and realizes how troublesome
for him to pinpoint the cause.
His first step is to take
a longer history. Should the cough have
lasted more than 8 weeks it is labeled as
chronic, that is, long lasting, and not
about to simply fade away on its own so
quickly.
Most commonly this has not
been the first occurrence of this type of
experience. Happily that in itself lessens
the likelihood of the condition being
anything serious. Also in managing the
nagging cough one can first borrow from
whatever proved helpful in the past or at
least not initially re-visiting what failed.
Following the history a
physical examination is done.
What should generally not
be sought is a bundle of laboratory
examinations and X-rays -particularly the
more expensive C-T scans. These are reserved
for later if the more appropriate first
steps fail.
Among possible diagnoses
include allergy, asthma, chronic lung
disease, pneumonia, GERD, postnasal drip,
sinusitis, bronchitis, laryngeal disease,
foreign body, side effect from other
medications, and psychological issues. Many
of these are the consequence of poor air
quality, smoking, airway inflammation,
primary infections and their complications.
At this time I prefer
identifying what I found as the hidden cause
in most patients. I would not likely have
found ‘the answer’ but for my own earlier
unsuccessful journey through the above
processes
By the time I examined the
patient he typically had gone through most
of the above management. Home treatment
failed; medical treatment aimed principally
at infection, allergy, asthma, and gastric
reflux likewise was unhelpful. Simplistic
statements that it must be the pollution
proved unfulfilling.
In fact I found the
persistent cough mostly due to a low grade
sino-bronchitis. It was an aftermath to the
common cold, or a bout of the ever
increasing sinusitis. Some term the
condition ‘cough variant asthma’. I don’t
like this name; it isn’t asthma, it is
bronchitis. It isn’t an active infection; it
is a residual inflammation of a prior
injury, be it infectious, or irritative, for
example, from allergy, pollution, or injury.
The quick and dirty
treatment is oral corticosteroids – the
prime anti-inflammatory agents of all. No
other medication has its effective benefit.
A seven to ten day treatment with a pulse of
prednisone proves successful in almost every
instance.
Nothing seems to relieve a
victim more than finally securing relief.
The fear of never getting well from some
horrible disease is lifted and the patient
becomes a person again.
Bill Ziering
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