Chronic cough has three major causes
DEAR DR. DONOHUE: For about a year, I have been plagued by an irritating cough. When it started, it was so severe that I fractured my spine. An ENT (ear, nose and throat) doctor said it was due to the trickle of postnasal drip. I then saw an allergist, who found no allergies. He had me stop taking the blood pressure medicine lisinopril. No help. I saw another ENT, who could offer no solution. If you have any ideas, I would appreciate them. — M.K.
ANSWER: A cough has a purpose. It clears the airways of secretions and foreign material. Coughs lasting for more than two months are called chronic coughs, and these coughs rarely serve a useful purpose. The irritation they cause makes them self-perpetuating.
Asthma, postnasal drip and GERD (gastroesophageal reflux disease; heartburn) are the three major causes of chronic cough. Other possibilities include medicines. Your lisinopril (Zestril, Prinivil) is one. It’s an ACE inhibitor, a class of medicines most effective for blood pressure control but that often cause coughing. Cancer is another cough-causer, and it’s a most serious cause. If you haven’t had a chest X-ray, you should have one.
Asthma can occur without wheezing. That kind of asthma is best discovered through breathing tests.
Postnasal drip, the annoying trickle of mucus into the throat, stimulates a reflex cough. Nasal irrigation with saltwater and nasal decongestants can put an end to postnasal drip.
GERD, gastroesophageal reflux disease, is the up-splashing of stomach acid and digestive juices into the swallowing tube — the esophagus. Those juices can reach the throat and trigger coughing. Heartburn is usually the prominent symptom, but the reflux can occur without any heartburn. I see you used to take omeprazole but stopped. Why? It’s suppresses stomach acid production.
Have you tried simple things to soothe the throat irritation that triggers coughing? Cough lozenges are helpful. So is sipping warm beverages, like tea. If you’re getting nowhere fast, a visit to another ENT or a lung doctor would be the route to take.
DEAR DR. DONOHUE: I read an article about a man who underwent chemotherapy for treatment of lymphoma. He was then stricken with shingles. I, too, had chemotherapy and radiation, and in my last week of therapy, I was struck with shingles. Is there a connection here? — C.P.
ANSWER: Shingles results when the awakened chickenpox virus travels down nerves to the skin. The virus lives with a person for life once he or she has been infected. Later in life, when there’s a temporary lapse in immunity, the virus leaves the protection of the nerve it has lived in, and the result is a shingles outbreak. Chemotherapy and radiation lower one’s immunity. The outbreak of shingles with chemo or radiation is connected.
The booklet on shingles explains this scourge of older ages. Readers can obtain a copy by writing: Dr. Donohue — No. 1201, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: I am a 62-year-old man with some health issues. I take prescription drugs for diabetes and high blood pressure.
At my last exam, a blood test for PSA was 2.65. My sister says this is too high, but my doctor says it is of no concern. Who is right? — D.F.
ANSWER: The doctor.
Most experts set the upper limits for normal PSA at 4 for someone of your age. PSA — prostate specific antigen — generates a lot of debate among those who are qualified to promulgate the best ways for detecting prostate cancer. Arguments about this test and its values haven’t been settled to everyone’s satisfaction, but the 4 number is a safe number for you.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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