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from Singapore asked a question

What could be the cause of chronic cough at night and in early morning? How can I stop the cough?

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Dr Lynne Lim
Dr Lynne Lim
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Dr Kenny Pang
Dr Kenny Pang
(14 Reviews)
7 answers on DxD

Ear, Nose & Throat

My mom has been having a chronic cough for almost a year. Her coughing occurs almost exclusively at night and in the early morning. She’s seen a respiratory specialist (found evidence of mycoplasma infection and treated it with antibiotics), but it didn’t clear up the problem completely. X-rays showed that her lungs were clear after the antibiotics. She then saw both ENT and a gastroenterologist – the former said she had slight rhinitis and prescribed nasal sprays, the latter said she had bad acid reflux and gave her Nexium. Most recently her GP gave her Seretide because he thought it might be some sensitivity in her airways. We are administering everything (nasal spray, Nexium, antacids, Seretide) twice a day, but she isn’t getting better. Her coughing is so bad that she’s ended up in the A&E several times, but the doctors can only give her cough mixture after checking that her X-rays are clear. What else can we do? Please advise.

DOCTOR’S ANSWER (1)

Dear ali8,

Thank you for your question. I’m sorry to hear that your mother is suffering from a prolonged and problematic cough which can be a complex condition.

Cough, is a reflex that protects your upper airway and lungs from irritants such as excessive mucous and foreign bodies. When persistent, it is often a symptom of a condition, ranging from conditions arising from the nose & sinuses (e.g sensitive nose, sinus infections), lungs (e.g asthma and bronchitis), throat and stomach (e.g. acid reflux from the stomach) to side effects from medications or smoking.

If the source of the cough is not found, it is difficult to treat. It would be beyond the scope of this Q&A to address all possible causes of prolonged cough.

The majority of prolonged coughs are due to:

  1. Postnasal drip
  2. Acid reflux
  3. Asthma
  4. Bronchitis
  5. Smoking
  6. Side effects from medications.

Since it seems that your mother has been cleared by a Respiratory Physician, we will discuss cough from irritation of the voicebox.

This is usually due to postnasal drip (back drip of mucous from nose allergy or sinus infection) or acid reflux from the stomach.

As the voicebox is a very sensitve organ, once inflamed, it can take months for the inflammation to resolve. It is important to remove the sources of irritation while waiting for inflammation of of the voicebox to resolve.

Since your mum has seen an ENT Specialist and was given an acid suppressant medication (Nexium) and nasal steroid sprays (to treat sensitive nose or nose allergies),  it is important to ensure good compliance with these medications.

The importance of compliance with nasal steroid sprays is often overlooked by many patients. It can take days to weeks for nasal steroid sprays to reduce the mucous in the nose and postnasal drip (which may be a possible source of irritant of your mother’s cough).

Apart from taking Nexium, it is also just as important to ensure that your mother adheres to antireflux measures (e.g no food/drinks 3-4 hours before sleeping, taking small meals and avoiding reflux causing or “heaty” food).

If your mother has done all that I’ve mentioned above, it may also be worthwhile to get her doctor to examine the medications that she is taking (one of the common blood pressure medication can cause cough as a side effect).

Exposure to cigarette smoke can also persistently irritate the voicebox and prevent a full recovery. As your mother’s cough started after a chest infection, she may also have “Postinfectious Cough”, of which the reason is unfortunately unknown.

Some studies attribute this to excessive inflammation of the upper and lower airway after an infection, resulting in a persistent overproduction of mucous. This is difficult to treat and often needs mucous thinners/expectorants and cough medications to keep the symptoms under control or bearable.

If your mother’s cough is accompanied by a whooping inspiratory sound or leads to vomiting, she may need to revisit the Respiratory Physician to rule out  infection that is due to B pertusis bacterial infection.

Hope this helps and all the best.

0 438 views 0 Doctors agree Fri Jan 26 2018 03:27:30 GMT+0000 (UTC)
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