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Chronic (long-term) coughing very rarely improves with antibiotics
alone. The most common causes of a persistent cough are posterior
nasal drainage, asthma and gastro-esophageal reflux.
Posterior nasal drainage results from mucous and fluid draining
backwards into the throat and onto the vocal cords. Patients with
this problem usually experience a tickle or irritation in the back
of the throat. They may also notice sinus pressure or pain and a
stuffy nose. Persistent nasal drainage may result from allergies,
viruses or environmental irritants. Doctors commonly treat the problem
using nasal sprays to decrease inflammation as well as decongestants
for drying out the mucous membranes of the nose. Your doctor may
also evaluate you for any allergies or other environmental irritants.
Unrecognized asthma also commonly causes a persistent cough. Asthma
effects almost five percent of the US population and causes intermittent
inflammation of the bronchial tubes in response to exercise, allergies,
viruses or other triggers. Patients with mild asthma often complain
of a dry cough, noisy breathing and shortness of breath. If your
cough is from mild asthma, your doctor can easily treat the problem
with a variety of inhaled medications.
Acid reflux from the stomach into the esophagus and windpipe may
also cause persistent coughing. These patients sometimes complain
of heartburn or indigestion after eating. They also sometimes complain
of a foul taste in the mouth, but in some cases cough will be the
only symptom. Your doctor can also easily correct this condition
by using medications to reduce the acid production from your stomach.
Other less common conditions causing persistent coughing include
lung tumors, regurgitation of food particles into the windpipe and
a variety of rare lung diseases. The vast majority of these problems
can be detected with a routine chest x-ray.
If your coughing persists, you should call your physician and discuss
these different possibilities. Your doctor will probably recommend
an x-ray and one or two additional tests to diagnosis the actual
cause of your cough.
Many patients with lung disease require oxygen. A famous study
done in England about 15 years ago proved patients with low arterial
oxygen levels lived longer by using oxygen at night. This famous
study used needle punctures of the artery in the wrist to measure
the blood oxygen level. The technology for measuring the oxygen
level in the blood has improved over the past two decades and healthcare
professionals no longer need to puncture the artery to measure the
blood oxygen level. We now measure oxygen levels using a painless
finger probe.
Most experts now recommend oxygen for any patients with a finger
probe oxygen measurement of less than 89%. If your oxygen saturation
(level) is less than 89% at rest, you should wear the oxygen as
much as possible. If your oxygen level only drops with exercise,
you only need oxygen with walking and sleep.
Medicare pays for oxygen in those patients who qualify. If you
only require oxygen at night, the doctor will probably prescribe
a concentrator. A concentrator is a machine weighing about 30 pounds
and standing around three feet high. The patient places the concentrator
near the bed and connects a small tube from the concentrator to
the nose. If you need oxygen during the day, your doctor will order
portable oxygen in addition to a concentrator.
Portable oxygen comes in several forms. Durable equipment companies
may provide compressed oxygen in large green cylinders. These cylinders
weigh five to ten pounds each and provide around two to three hours
of oxygen. I personally recommend one of the newer liquid oxygen
systems. The most up-to-date liquid system provides a portable tank
weighing around a pound and a half, which can easily be placed over
the shoulder and lasts for up to eight hours.
Cigarette abuse remains a major health problem in the United States.
Smoking increases the risk of suffering a stroke, developing lung
or bladder cancer and experiencing a heart attack. Smoking also
worsens osteoporosis and peptic ulcer disease. Quitting cigarettes
ranks high as one of the key things Americans can do to improve
their health and longevity.
Most experts now recommend selecting a “quit date”
and completely abstaining from tobacco use after the set date. Studies
demonstrate greater success with this “cold turkey”
method as compared with gradual reduction in cigarette use over
time. People may seek support through group counseling or encouragement
from their physicians and family members. Many programs also employ
hypnosis to help improve determination. Medical studies have shown
mixed results concerning hypnosis as an aide to smoking cessation.
Some studies showed a benefit from hypnosis and other studies demonstrated
no advantage.
Cigarettes contain an addictive drug called nicotine. Nicotine
acts as a stimulant in our bodies similar to caffeine or amphetamines.
When a person stops smoking, he or she may experience symptoms of
withdrawal, including anxiety, irritability, palpitations, weight
gain or difficulty sleeping. The average person gains about 10 pounds
after giving up cigarettes. The symptoms of irritability and anxiety
generally peak around three (3) to five (5) days after the last
cigarette, but cravings and some mood changes may persist for months.
Pharmacies sell several nicotine replacement therapies, which help
alleviate the symptoms of nicotine withdrawal. Nicotine replacement
therapies provide a small quantity of nicotine through a patch applied
to the skin, chewing gum, nasal spray or hand held inhalers resembling
plastic cigarettes. Doctors currently believe all these types of
nicotine replacement therapy are equally effective and no one method
stands out at this time.
Some physicians also recommend a pill called Zyban for up to two
months after quitting. Medical studies showed a greater success
rate in people taking zyban when compared to people taking placebo.
Zyban also decreased the weight loss and irritability in many patients
after quitting cigarettes, but keep in mind there are no panaceas.
No matter what pills, nicotine replacement therapies or support
groups a person employs, quitting cigarettes is not easy. It requires
determination, persistence and good old-fashion will power.
Smoking damages the lungs in several different ways. Smoking may
cause chronic irritation in the bronchial tubes resulting in wheezing,
coughing and phlegm production. Doctors call this type of inflammation
chronic bronchitis. Cigarettes also may destroy the tiny air sacks
in our lungs called alveoli. These alveoli normally extract oxygen
from ambient air we inhale. The destruction of these alveoli prevents
the lungs from deflating normally and limits the ability to exhale.
Doctors call this form of injury emphysema. Although some smokers
may suffer from only one of these types of injury, the majority
experiences a combination of chronic bronchitis and emphysema. Doctors
call this combination of problems chronic obstructive airway disease
or COPD.
Lung tissue does not regenerate and smoking related damage to the
lung is often permanent. The sooner a person stops smoking, the
less likely permanent lung damage will occur. Lung specialists use
Pulmonary Function Testing to determine if a person suffered any
injury from prior smoking as well as for measuring the severity
of injury. Pulmonary function testing is simple and can usually
be performed in the office of a lung specialist. The testing involves
several parts. First the patient exhales into a tube attached to
a computer to measure the force of exhalation. Next, the technician
will assist the patient with several easy maneuvers to measure the
size of the lungs and the ability of the lungs to extract oxygen
from the surrounding air. A thorough evaluation of the lungs also
requires a chest x-ray. The x-ray will detect any pneumonias, collapsed
lungs, or cancer.
If you smoked previously, do everything you can to quit now. If
you need to know if any injury has already occurred, ask your doctor
to arrange for a chest x-ray and pulmonary function testing.
Pollution can injury lung tissue. Autopsy studies show the lungs
of urban dwellers from highly industrial areas contain higher levels
of soot and black pigmentation than the lungs of people from rural
areas. Pathologists call this black soot imbedded in the cells lining
the tiny air sacks of the lungs anthracosis. Exposure to high levels
of pollution over a long period of time also increases a person’s
risk of developing emphysema or lung cancer later in life.
Pollution does more than just effect statistics. Air contamination
may adversely affect our breathing on a day-to-day basis. Patients
with chronic bronchitis or asthma often complain of more wheezing
and shortness of breath when the air quality is poor. Sudden exposure
to large amounts of smoke or exhaust fumes can also aggravate existing
lung disease.
Air contamination in the work place can also cause lung disease.
Lung specialists often describe a syndrome called occupational asthma.
This syndrome occurs when patients experience wheezing and difficulty
breathing only in the work place. Their symptoms improve on weekends
and during vacation. The inorganic irritants found in smoke, chemical
solvents, cleaning solutions, oils, or dust particles initiate a
cycle of inflammation and narrowing of the bronchial tubes. The
symptoms worsen in the work environment with exposure to these contaminates
and abate during vacations or time away from work. Physicians usually
find this problem difficult to treat without decreasing the amount
of air contamination and patients often need to change their work
environment.
If you want to know if air pollution damaged your lungs, you should
schedule an appointment with your doctor. He or she will most probably
recommend a chest x-ray and breathing tests called Pulmonary Function
Tests.
Influenza is a viral illness infecting patients during the late
fall and winter months. Influenza or the “flu” causes
muscle aches, fevers, runny nose and coughing. The illness usually
subsides after seven to ten days in otherwise healthy adults. Unfortunately,
in elderly individuals or patients with underlying diseases of the
heart or lungs, influenza may progress to pneumonia resulting in
a long disabling illness or even death.
Most authorities recommend people at increased risk receive a flu
shot annually in October or November. The vaccine does not guarantee
complete protection from the flu, but most authorities estimate
a 70 –80% reduction in influenza through use of the vaccine.
Those people who do contract the flu even after taking the vaccine
usually experience less severe symptoms.
Current recommendations suggest anyone over the age of sixty receive
a flu shot. Most authorities also recommend a flu shot for anyone
suffering from a chronic lung or heart disease including emphysema,
chronic bronchitis, heart failure or asthma. Healthcare workers
including nurses, doctors and medical office personnel should also
receive flu shots, as should pregnant women in their second and
third trimesters of pregnancy and residents of chronic care facilities
such as nursing homes.
The flu shot may cause local soreness at the injection site or
even a mild episode of muscle aches. Rarely, patients may experience
a severe allergic reaction to a flu shot. For this reason, the center
for disease control recommends against giving the flu shot to any
patient who experienced a previous allergic reaction to the vaccine.
Authorities also recommend against taking the flu shot if you have
any history of allergies to eggs since the vaccine is prepared through
the use of eggs. Patients who recently suffered from a neurological
disease called guillian-barre syndrome should also avoid taking
the flu shot, as should patients with severely compromised immune
systems.
Scientists recently developed a new intranasal vaccine against
influenza in the form of a nasal spray. The initial studies with
this vaccine showed promise and in 2003, the FDA approved the intranasal
preparation for children over the age of five and adults under the
age of fifty.
This will depend upon your insurance. Many health maintenance organizations
(HMOs) will require a referral from your primary physician. Patients
with Medicare, Medicaid, Champus, PPOs or any traditional indemnity
insurance may call our office directly for an appointment.
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