The previous post I spoke about the causes of a chronic cough due to nasal congestion and post-nasal drip. Today, I want to discuss when a chronic cough emanates from the chest. It seems obvious when a person is coughing that the problem is in their chest; however, a good allergist/physician should take a complete history and due a thorough physical exam which will point him in the right direction.
The classical signs of dark green sputum and a fever point to a bronchitis or pnuemonia; however, some infections like Mycoplasma pnuemonia, so called ” walking pneumonia”, typically have a high fever for just a day or two, but the hacking cough can last for weeks. I remember catching this infection after coming off a plane during a medical school break- I was coughing for weeks until I went to a physician who made the diagnosis and treated me with antibiotics- specifically the group of meds in the erythromycin class, which are more effective than penicillins for Mycoplasma.
The other category in the chest that can cause a chronic cough is bronchospasm. Patients that have increased bronchial reactivity(meaning their lungs “twitch” very easily to allergens and infections) often present with a chronic cough. As an NYC allergist/asthma specialist I have special breathing tests that allow me to assess the nature of the cough and it’s effect on the lungs. I do in my office a test called the Nioxmino, which is a simple breath test(you just blow into a small device) and it gives me a reading of the nitrous oxide in your breath. This simple and safe test can show if you have evidence of allergic inflammation in your lungs. I frequently see patients that have cats and dogs or rabbits in their homes and if they are allergic to them and have a cough I usually see a high nitrous oxide level. This can be easily treated with a mild cortisone inhaler, and stops me from thinking the patient has an infection and needs antibiotics.
