OpenHealth Q&A

Persistent Dry Cough for Two Months: Seeking Solutions

**Patient Information:** I’m a 36-year-old Caucasian male, weighing approximately 270 pounds and standing at 5 feet 11 inches tall. For nearly six weeks, I have been plagued by a dry, non-productive cough without accompanying symptoms. Currently, I reside in the Central Valley of California and utilize a Resmed Airsense 10 CPAP machine for my sleep since being diagnosed with central sleep apnea in July last year. My history includes being a daily smoker from 2007 until 2012, but I have since quit. Additionally, I consume alcohol rarely, perhaps once a year. **Initial Visit:** On February 6th, I visited an urgent care facility, primarily for what I suspected to be separate issues: jock itch in the groin area and athlete's foot affecting both feet. I was prescribed Lamasil topical cream along with Fluconazole to be taken daily for a week. However, the pharmacist expressed concern over this regimen, prompting the doctor to modify it to one pill weekly for eight weeks. During my visit, I had started to notice a heaviness in my chest. Historically, this time of year would bring a brief chest cold that resolved within a week or two, but I avoided mentioning it due to my general aversion to medical consultations and treatments. **Progression of Symptoms:** Shortly after the initial visit, I noticed the onset of a cough. It remained consistently dry and unproductive, devoid of pain or fever, which are common with respiratory infections. I did, however, experience unusual auditory sensations in my left ear, where sounds were tinny and overly amplified. I returned to urgent care on February 14th because my primary care physician was unavailable until early March. I was given prescription medications including promethazine/DM (5ml every 6 hours as needed) and prednisone (10mg for three days). Additionally, I was instructed to discontinue the Fluconazole to prevent potential drug interactions; my skin conditions had already improved. The cough syrup provided some relief, while the prednisone significantly alleviated my exhaustion, enabling me to be more productive for a few days. The auditory problem resolved within a day and a half. **Continuing Issues:** Despite these treatments, the cough persisted and contributed to headaches and soreness in my lower back without any noticeable changes. This frustration led me back to urgent care, where I felt increasingly drained and discouraged by the lack of improvement. I received another prescription for prednisone at a higher dosage (20mg for three days). An attempt was made to prescribe me an inhaler (either Advair or Qvar), but my insurance denied coverage and the out-of-pocket cost was $298, so I opted not to obtain them. The increased prednisone dosage helped me manage the work week and provided slight relief for the cough, but once I stopped taking it, the cough returned unchanged. **Further Medical Evaluation:** On March 10th, I finally had an appointment with my primary care physician, who arranged for lab work and a chest X-ray. The lab results showed elevated LDL cholesterol and triglyceride levels, along with low vitamin D, suggesting I should increase my water intake possibly due to dehydration. The chest X-ray returned with normal results, indicating no focal consolidation. **Current Condition:** I remain uncertain about my persistent cough, which begins shortly after waking and continues until I sleep. My wife has thoroughly cleaned our bathroom to rule out mildew as a potential trigger. I've experimented with the humidity settings on my CPAP machine, finding that I don’t cough at all while using it, regardless of the current settings. However, once I shower and head to work, my cough begins minimally and progressively worsens throughout the day, particularly intensifying by the time I return home. **Possible Explanations:** I suspect my CPAP usage may have caused a sensitivity to allergens that previously did not affect me, or possibly triggered a form of reactive asthma. We own cats and live in an older house with a leaky roof corner that is resealed every December, raising concerns about mold, although facilitating timely repairs has proven challenging. Additionally, living in the Central Valley, surrounded by farmland, could contribute to allergens affecting my respiratory health, though I’ve never before experienced significant breathing issues. **Seeking Advice:** The only remedy that provides consistent relief is cough drops, which appear to open my airways and improve my breathing slightly. If you have taken the time to read through this detailed account, I would deeply appreciate any suggestions or insights into identifying the cause of my persistent cough and recommendations for potential solutions to facilitate my recovery.

Answers (1)

3/20/2025, 3:20:53 AM

OpenHealth AI

It sounds like you're experiencing a frustrating and persistent dry cough that isn't responding well to treatment after several weeks. Let's break down your situation and focus on key possible causes and actionable steps you can take.

Main Points:

1. Possible Causes of Cough: The dry cough you're experiencing could be linked to allergic reactions, environmental irritants, or even the use of your CPAP machine.
2. Immediate Steps to Manage Symptoms: There are several self-care measures and adjustments you can make to help alleviate your cough and improve your overall comfort.

Explanation:

Your history, living environment, and use of the CPAP machine might be contributing to your cough. Given that you've noticed relief when using the CPAP, it suggests that the controlled atmosphere might be reducing irritants. At the same time, exposure to allergens or irritants during your daily routine could be triggering your symptoms when you’re not using it.

1. Environmental Factors:

   • Allergies: Cats, mold, and dust can worsen respiratory symptoms. Cleaning, especially in areas like the bathroom where moisture can accumulate, is helpful. Even with cleaning, consider using air purifiers that can reduce allergens and irritation in the home.
   • Workplace irritants: If you are exposed to dust or chemical irritants at work, a mask could help reduce exposure.

2. Sensitivity to CPAP Usage: How you feel different while using your CPAP suggests you might be sensitive to something in your environment. The humidity setting you’re experimenting with could also play a role in moistening dry air, helping to soothe your throat.

Specific, Prioritized Next Steps:

1. Hydration: Increase your fluid intake to help keep your throat moist and soothe irritation. Aim for at least 8-10 cups of water a day.

2. Air Quality Improvement:

   • Use a Humidifier: If your air is dry at home (common in Central Valley), consider using a humidifier in your bedroom, aiming for around 30%-50% humidity.
   • Air Purifiers: Using HEPA air purifiers in your home, particularly in bedrooms or areas where you spend time, can help reduce allergens from pets and dust.

3. Monitor Symptoms: Keep a symptom diary to track when your cough worsens, potential triggers, and the effectiveness of remedies (like cough drops). This record can help identify patterns and identify possible irritants.

4. Dust and Allergen Management: Consider regularly vacuuming (with a HEPA filter) and using hypoallergenic covers on pillows and mattresses to reduce exposure to allergens.

5. Medication Adjustment: If cough drops provide significant relief, discuss this with your doctor. Some over-the-counter antihistamines or other cough suppressants might also help, though it’s best to confirm with a healthcare provider before starting new medications.

Conclusion:

Understanding the environmental triggers and making the necessary adjustments can lead to improvements in your cough. Continue monitoring your symptoms and environmental conditions actively. If your cough persists despite these measures, further evaluation for allergies or potential asthma might be warranted with your primary care physician. Let me know if you have further questions or need clarification on any of these points. Take care!