long time cough
Question:
> Five years ago my MIL developed a wheeze and cough following a knee > replacement. We’ve always wondered if there was a connection. She has been > coughing almost continually ever since. She has had physicals, seen > allergists, pulmonary studies (normal), cardiology studies, been on all > kinds of antibiotics and asthma drugs, expectorants and decongestants, and > long term steroids. No one has been able to determine the cause of her > cough or to relieve it. It has affected the quality of her life (she’s now > 71). Any ideas? Thanks
See these links on cough: http://www.vh.org/Providers/ClinRef/FPHandbook/Chapter04/10-4.html Pulmonary Medicine: Evaluation of the Chronic Cough "I. Most common causes in order of frequency. Postnasal drip/chronic sinusitis, asthma, including postviral reactive airways, GE reflux disease. Consider also medication (ACE inhibitors), CHF, pertussis, TB. Pertussis in adults may present only with chronic cough and may be present despite childhood immunization and represent 21% of those with chronic cough in one series (check acute and convalescent titers). II.One Approach. A.Treat with antihistamine or decongestant empirically. Consider course of antibiotics for sinusitis if appropriate. B.If positive titer for pertussis, treat with erythromycin or other macrolide. C.If this fails, do bronchoprovocation testing for asthma and treat patients with positive results with beta-agonists and prednisone (if fail, beta- agonists alone). D.If cough continues or bronchoprovocation is negative, do CXR and sinus CT. Treat positives. E.Evaluate negatives for GE reflux and give trial of H2-blocker. F.If patient still coughing, consider bronchoscopy. G.This approach leads to successful treatment in 96% (though there are recurrences)." http://www.aafp.org/afp/981200ap/lawler.html An Office Approach to the Diagnosis of Chronic Cough [American Academy of Family Physicians] http://www.chestnet.org/health.science.policy/patient.education.guide… Cough [patient info] Ellis
Response:
Five years ago my MIL developed a wheeze and cough following a knee replacement. We’ve always wondered if there was a connection. She has been coughing almost continually ever since. She has had physicals, seen allergists, pulmonary studies (normal), cardiology studies, been on all kinds of antibiotics and asthma drugs, expectorants and decongestants, and long term steroids. No one has been able to determine the cause of her cough or to relieve it. It has affected the quality of her life (she’s now 71). Any ideas? Thanks
Response:
> Five years ago my MIL developed a wheeze and cough following a knee > replacement. We’ve always wondered if there was a connection. She has been > coughing almost continually ever since.
Can you give us some more info: When you say "ever since," do you mean that the wheeze & cough developed in only a week or so after the surgery? If so, that sounds like one of two things: – phlebitis: A blood clot occurred, and traveled to the lung. – a reaction or damage caused by anesthesia or blood thinners when she was intubated. Those things happen more often than surgeons are willing to admit. Your MIL should ask for a copy of the surgeon’s surgery report, which will indicate what anesthetics were used, and whether any anomalies occurred during the operation. What medications is your MIL taking on a regular basis? There are prescription meds that can actually cause chronic cough and even bronchospasm. It’s remarkable how many physicians just don’t know about those side effects which are considered "rare" (incidence under 1%). Finally, you may want to repost your query to sci.med That deals with more general medical issues, and you might get more pointers there. Good luck. — Steven D. Litvintchouk
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