Have had chronic cough for 6 months, dry unproductive Previous

Patient

Q: Have had chronic cough for 6 months, dry unproductive. Previous smoker, quit 2 years ago. have been seeing a pulmonary specialist for last 6 months, diagnosed with asthma and severe allergies. On qvar 40 mcg, proair, allergra, benedryl, tessalon pearls 600 mg at night. Previously on tussionex for night time (cough worse at night die to inability to sleep) followed up with doc, have bronchcoscopy scheduled in two weeks. Doctor stopped tussionex and had me try 2 pills of Tylenol 3 at night This weekend. Severe abdominal cramping and vomiting, had to stop..prescribed Zofran for nausea and vomiting this morning when I called to inform them of the negative side effect. Doctor is at a conference so my question was deferred to a PA on staff. PAs nurse called me and told me to stop Tylenol 3 and take OTC robitusson. The specialist would not have prescribed such a strong med if it were possible to only take OTC medication. The tyleno 3 did nothing for the cough except make me vomit profusely. OTC cough med does not work for the cough, even when adding tessalon pearls to it At night, as I have tried this several times in desperation to stop the cough.

I have called the office again asking if it is OK to try 800 to 900 mg of the tessalon pearls to try and see if that calms the cough. The office has not called me back and have not been very supportive or interested in solving this problem.

I had just visited my specialist on friday, 3 days ago. The PAs nurse said that if the nausea doesn't stop that I will need to go in for a followup..which is ridiculous because I just met with my specialist and my ongoing and immediate issue isn't nausea it is the cough and my anxiety over the horrific and painful coughing that I will experience tonight. I will cough sometimes until I vomit...been on antibiotics for possible whooping cough and tested..test came up abnormal, but doc thinks this is from antibodies from my vaccine years ago.

Please tell me if I can just take 900 mg of these benzonatate pearls tonight with OTC cough med so I don't hurt myself coughing and lose sleep. :( thank you

Doctor

A:   Hello,
Thank you for your medical query at AskTheDoctor.com
I understand your concern.
Regarding the Benzonatate, the recommended regimen is 100 mg tablets to be taken thrice a day after every 6-8 hours. If the coughing is severe the dose can be increased up to 200 mg per day, but 600 mg is the maximum medicine in a day. I will strictly advise you not to cross the 600 mg dose, as you will end up with severe side effects such as nausea, fatigue, headache, e.t.c
You can take an OTC cough syrup in addition to the Benzonatate, or you can take an antihistaminic like Levocetirizine 5 mg once daily till the cough subsides.

2 pills of Tylenol 3 at the night should have been avoided, as it is a strong drug and affects the liver directly. I am not sure from your history, why did the doctor recommend Tylenol 3 2 pills. The vomiting and nausea that you started is a side effect of the drug. The liver is very sensitive to Tylenol and 2 pills should not have been taken together.

I will advise you to get a second opinion, as I do not suggest the same medicines that the doctor prescribed to reduce the nausea. If you did take 900 mg, you will have further retching and vomiting.

Hope this was helpful,
Feel free to discuss further,
Regards.

Comments / Follow Ups

Patient: Hello Doctor, thank you so much for your reply. The receptionist at the pulmonary doctors office just called me back 20 minutes ago. The desk receptionist relayed the msg from the Physicans Assistant and told me to keep taking the 600 mg of tessalon pearls and just to add Nyquil at night along with them. I am very upset that the PA herself could not call me back about this. The care they give is sub par when their main specialists are on vacation or at medical conferences.

I am not sure either why Tylenol 3 was given for the cough, as it isn't even marketed as a cough suppressant AND since diagnosed with asthma, doesn't Tylenol exacerbate asthma??? This practice is supposed to be one of the best for pulmonary issues, but they have not been able to find a direct cause of the cough and I am still coughing 6 months later. I have had a pulmonary breathing test done, which was normal; also had a methacholine challenge, which came back as positive for asthma. I just turned 35 and have never had asthma in my life before the cough started. I have had 3 xrays, and one CT scan of the lungs after the specialist noted that he saw intertisial (spelled wrong) markings, but the follow up high contrast CT scan showed nothing abnormal..so all tests were clear, no issues. They have me scheduled for a bronchcoscopy on Monday the 13th to see if I have a "dysfunctional flap" or something else going on. I am truly at my wits end, Doctor. I have spent a lot of money trying to diagnose this and still I am suffering with this cough..it isn't a tiny cough-cough, it is a nasty, dry hacking cough. I have coughing fits that last anywhere between 10 to 20 mins, several times a day. It was so bad on Friday after my last appointment with the specialist that when I got home I was coughing so hard I was dry heaving.

I have awful anxiety that I am going to cough myself into a hernia or worse, a rib fracture. At work I am coughing so hard I wretch and have tears streaming down my face. :( The specialist does not return to the office until late next week, so I do not know what I am supposed to do until then if the 600 mg of pearls and OTC cough medicine does not work well during the day, but I am more worried about nighttime. I work every day from 5 am until 3pm, and need my sleep to function. It has been a nightmare for the last 6 months and I feel like my quality of life is terrible..no sleep, I am embarrassed at meetings at work from the cough, etc.

What would you suspect may be causing this cough all of this time? I mentioned I have also been on QVAR 40mcg twice a day, Nasonex for post nasal drip, Proair Arbuterol every 4 hours, Allergra allergy med in the day, tessalon pearls all day and night along with benedryl. None of this stuff works. When the cough first started, it began with a nasty cold and sore throat..it was worse then than it is now as I was literally coughing every hour, twice an hour for 20 minutes straight..I could hardly catch my breath and would tear and nearly wet my pants..so embarrassing. :( As of 6 months later it is not as bad as that, but still a nuisance and worse, it is ruining my quality of life with its ferocity. Please, please help and give me your thoughts and medically professional advice on what could be causing it! Thank you so, so much.

Doctor: Hello,
Thank you for the follow-up.
I can understand the difficulties you are facing and the quality of life you have been subjected too because of this coughing.

Since all the other tests are normal, there is no evidence of any infection, neither there is any evidence of any chest findings which may cause such coughing. It seems more allergy oriented, and that is the only time when you have a severely dry cough, and, unfortunately, this does take a long time to settle down.

A combination of physical examination, CT findings, and history is required for the diagnosis. Please get back to me once you have the bronchoscopy report. You are also taking all the medicines required to suppress it. So let's wait for the bronchoscopy if it is able to point to something specific.

Hope this was helpful,
Regards.

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