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Respiratory Disorders (Expert Forum)
Coughing spasms/losing consciousness
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Coughing spasms/losing consciousness
by arsegja, Oct 15, 2003 12:00AM
I am writing about my father - a 68 year old white male, 5'10", and weighs 225 lbs. He has been getting coughing spasms that have caused him to pass out occasionally. It started soon after he was taken off of Prednisone. He was taking Prednisone for 8 months for Colitis.
You can hear him wheezing when he breathes. His
pulmonary specialist first diagnosed asthma and prescribed inhalers. The inhalers did not seem to work. Then the pulmonary specialist told him to get his esophagus checked out. Below is a list of tests that he has taken:
2000 - Stress Test – Passed, 7/29/02 Chest X-ray - Normal, 8/05/02 ECG Monitor Review - Normal’ 8/30/02 Electroencephalogram – Normal
9/4/02 Residual Lung Capacity test & Monoxide diffusing capacity, 10/10/02 Diagnostic Laryngoscope, 11/04/02 Breathing capacity test, 8/27/03 Chest X-ray – Normal, 9/18/03 Panendoscopy, duodenum - normal, stomach - normal, esophagus appeared normal and hypo pharynx appeared normal.
Medications that he is taking:
Avapro, Asacol for Colitis, HCTZ for blood pressure, Zocor for chloresterol, Asprin , Protonix Pantoproazol for reflux (works well), Serevent for asthma, Flovent for asthma (both inhalers do not work), Advair – discontinued (allergic reaction – hives)
He has allergies. He also had his esophagus stretched years ago when food got caught in his throat. I am wondering if that may have caused some of this now.(a long shot)
What could be causing these coughing spells? What doctors do we need to go. Is the combination of medications a problem. Also, could it be the vegas nerve?
You can hear him wheezing when he breathes. His
pulmonary specialist first diagnosed asthma and prescribed inhalers. The inhalers did not seem to work. Then the pulmonary specialist told him to get his esophagus checked out. Below is a list of tests that he has taken:
2000 - Stress Test – Passed, 7/29/02 Chest X-ray - Normal, 8/05/02 ECG Monitor Review - Normal’ 8/30/02 Electroencephalogram – Normal
9/4/02 Residual Lung Capacity test & Monoxide diffusing capacity, 10/10/02 Diagnostic Laryngoscope, 11/04/02 Breathing capacity test, 8/27/03 Chest X-ray – Normal, 9/18/03 Panendoscopy, duodenum - normal, stomach - normal, esophagus appeared normal and hypo pharynx appeared normal.
Medications that he is taking:
Avapro, Asacol for Colitis, HCTZ for blood pressure, Zocor for chloresterol, Asprin , Protonix Pantoproazol for reflux (works well), Serevent for asthma, Flovent for asthma (both inhalers do not work), Advair – discontinued (allergic reaction – hives)
He has allergies. He also had his esophagus stretched years ago when food got caught in his throat. I am wondering if that may have caused some of this now.(a long shot)
What could be causing these coughing spells? What doctors do we need to go. Is the combination of medications a problem. Also, could it be the vegas nerve?
Doctor's Answer
by National Jewish, Oct 24, 2003 12:00AM
, Oct 24, 2003 12:00AM
In a person who has a normal chest x-ray and who doesn’t smoke the most common causes of chronic cough are reflux, postnasal drip, asthma, and chronic sinus problem. Since the panendoscopy was normal, it would appear that the Protonix® (pantoprazole) is controlling your father’s reflux. A chronic cough can be a side effect of a group of medicines called angiotensin converting enzyme (ACE) inhibitors, like the Avapro® (irbesartanan) that your father is taking for his high blood pressure.
Postnasal drip is drainage from the nose and sinuses dripping down the back of the throat. Prednisone will often control postnasal drip, so this may have worsened when the prednisone was stopped. There could be several reasons for this drainage. One is an allergic reaction to inhaling something. A second reason is a non-allergic, non-infectious inflammation in the sinuses that can linger after a cold. A third reason is chronic sinusitis. Postnasal drip can cause coughing and wheezing as a result of irritation of the throat and lungs. As long as your father is not on a fluid restriction he should be drinking 6 to 8 8-ounce glasses of non-caffeine non-alcoholic fluid daily. This will thin the phlegm so that it moves more easily. A nasal wash helps remove phlegm from the nose and sinuses. This can temporarily reduce the postnasal drip and lessen the coughing and wheezing. A prescription nasal steroid spray decreases nasal swelling and phlegm production. This may prevent the postnasal drip and coughing and wheezing. To get the most out of a nasal steroid spray use it after doing a nasal wash. A nasal steroid spray does not provide immediate relief of symptoms. It may require several weeks of routine use to become effective. Please read our Nasal Wash MedFact at http://www.nationaljewish.org/medfacts/nasal.html for more information about this technique. Share this information with your father’s doctor to see if he would benefit from this daily treatment.
Since the asthma inhalers do not seem to work, a methacholine challenge may be helpful. This test is the gold standard for diagnosing asthma. Your father will blow into a spirometer before and after each increasing dose of an inhaled medicine. This test is positive for asthma if the result after the inhaled medicine is 20% lower than it was before the inhaled medicine. Although the chest x-ray was normal, it may be possible that your father has inhaled a non-opaque foreign body into his lungs. Since it is non-opaque it will not show up on a chest x-ray. A pulmonologist would be the type of specialist to identify if your father’s symptoms are due to a lung problem and the best treatment.
Postnasal drip is drainage from the nose and sinuses dripping down the back of the throat. Prednisone will often control postnasal drip, so this may have worsened when the prednisone was stopped. There could be several reasons for this drainage. One is an allergic reaction to inhaling something. A second reason is a non-allergic, non-infectious inflammation in the sinuses that can linger after a cold. A third reason is chronic sinusitis. Postnasal drip can cause coughing and wheezing as a result of irritation of the throat and lungs. As long as your father is not on a fluid restriction he should be drinking 6 to 8 8-ounce glasses of non-caffeine non-alcoholic fluid daily. This will thin the phlegm so that it moves more easily. A nasal wash helps remove phlegm from the nose and sinuses. This can temporarily reduce the postnasal drip and lessen the coughing and wheezing. A prescription nasal steroid spray decreases nasal swelling and phlegm production. This may prevent the postnasal drip and coughing and wheezing. To get the most out of a nasal steroid spray use it after doing a nasal wash. A nasal steroid spray does not provide immediate relief of symptoms. It may require several weeks of routine use to become effective. Please read our Nasal Wash MedFact at http://www.nationaljewish.org/medfacts/nasal.html for more information about this technique. Share this information with your father’s doctor to see if he would benefit from this daily treatment.
Since the asthma inhalers do not seem to work, a methacholine challenge may be helpful. This test is the gold standard for diagnosing asthma. Your father will blow into a spirometer before and after each increasing dose of an inhaled medicine. This test is positive for asthma if the result after the inhaled medicine is 20% lower than it was before the inhaled medicine. Although the chest x-ray was normal, it may be possible that your father has inhaled a non-opaque foreign body into his lungs. Since it is non-opaque it will not show up on a chest x-ray. A pulmonologist would be the type of specialist to identify if your father’s symptoms are due to a lung problem and the best treatment.
Has he been back to the Pulmonologist after all these tests? Also being overweight can contribute to many of his health related problems, even the asthma. Hopefully he is a non-smoker? If not, that would definitely cause the asthma to flair.
I assume since he's seeing a Pulmonologist, they have ruled out other lung problems such as Chronic Pulmonary Obstructive Disease (COPD) and Emphysema?
It definitely seems like further medical evaluation is necessary. If you are not happy with the current Pulmonologists answers, seek a second opinion. Good luck!