Not asking you to make a diagnosis - but need your suggestion re next steps for DH

[Sidebeforeself]

My DH has had a cough for about 7 months now. During that tim he has had a major health scare which has meant he is on new tablets. I have been urging him to get the Dr to address his cough. Hes had a chest X ray that came back clear so the Dr is just saying it’s a side effect of new tablets. But that doesn’t make sense as he had the cough before he got ill.

Im very worried as it’s not like him and I feel they are dismissing him. I recall up till fairly recently there was a health campaign along the lines of “ If you’ve had a cough for 3 weeks or more see your GP”.

What should he ask for as a next step , given the fact he has had a clear X-ray? I feel now is the time to get insistent.

Could it be asthma. There is a type where the main symptom is coughing.

Thanks …wouldn’t that show up on an X-ray? ( I genuinely dont know!). I just dont want him to get fobbed off again , and go in prepared with some specific requests , if you see what I mean.

I believe some blood pressure medication can cause a cough

Is he on beta blockers?

My asthma mostly presents as coughing. Most of my asthma attacks were just extreme coughing fits from the airway irritation. Inhalers fix it like usual. I don't think it would show up on an xray.

Ask the GP or a nurse to test his peak flow and O2 saturation (quick simple tests they can do on the spot in the office). They'll probably also have a listen for any wheezing.

He should be assessed for chronic cough. It could be asthma, it could be allergies and therefore post nasal drip, a clear chest xray rules out a bunch of the big nasties though. Does the cough bother him, keep him awake, does he have any other symptoms….

Is it the same cough pre and post starting the medication?

Has he tried a ppi for reflux because that can cause a cough? (If he can take them safely)

What kind of cough is it? Any other symptoms? What medication does he take?

Thanks everyone. He is on blood pressure meds yes but has been for years so Im surprised they should cause a cough now? Although they have changed the type. It is the same cough though that he had before they changed them. It’s bothering us both especially during the night . Some days are worse than others.

@DoAWheelie Thanks I will get him to ask for that!

Asthma doesn't show up on an x-ray. I was diagnosed at 40 with adult onset asthma after coughing for months with no other symptoms of illness. I now have preventer and reliever inhalers - currently on higher doses of both as I'm recovering from flu which causes my asthmatic cough (it has a high pitched wheeze at the end signalling that not enough air is getting into my lungs). If he won't talk to his GP get him to make an appointment with the asthma nurse as she'll either rule it in and start him on inhalers or she'll get the GP to look at him.

Have you read the leaflet with the BP meds? Some do cause a cough.

HCP here. Some general considerations here so please don't take this as any form of diagnosis! Make sure he persists with the GP.

Re BP medication, most likely ramipril, is well known to have cough as an adverse side effect. If your husband didn't tell the doctor the entire truth about the coughs duration, it would be reasonable for the GP to think it was that.

Have they done speutum samples? Is it a productive cough, if so what colour phlegm is he producing and how often?

I would also be thinking about whether it could be reflux or post nasal drip. People are quick to fob these ideas off but actually more often than not this is the case. Does he have any sinus type pain?

A 'normal' chest x-ray doesn't rule out things like infection or asthma.

If it were me I would ask the patient to keep a peak flow diary (get him prescribed a peak flow monitor) and booked for spirometry.

Does he have any history of smoking or being around smokers in his life (ie passive smoking?).

Thanks @rubyrubyrubyrubymurray !
He has been honest with GP - just not assertive in my opinion. The cough predates the change in meds. He had a mild virus ( could have been Covid but we didnt test ) but the cough was present before that .
There was some wheezing but that has gone. Not productive as such but he sometimes sounds a bit phlegmy when he talks ( sorry TMI!).
Not smoked for 8 years or so . I will get him to ask for the tests as you suggest - thanks so much.

Second the post nasal drip suggestion.
My DH is very fit and healthy, when he had covid you wouldn't have even know but he did developed a cough for months and months which was worse at night and like he had to clear phlegm constantly.
He was prescribed a steroid spray for the doctor and it stopped.
He only went to the doctor as I was sick to death of hearing him cough and ended up making the appointment for him.

How much did he smoke and for how long? Spirometry can also be used to assess for COPD (don't panic).
Let me know how he gets on.

He had smoked on and off for about 30 years but not heavily - maybe 3/4 a day.Absolutely nothing for past 8 years though.

Thanks for your advice - will report back!

It can take a while for the impacts of smoking to show themselves, unfortunately.

I haven't read all the comments so maybe repeating but my asthma causes a chronic cough. Another thing that can cause it is GERD. Often confused for asthma but can be a result of a silent type of reflux.

X ray will not show up asthma or many other lung issues such as COPD. Ideally he would get referred for spirometry as this will give a lot of information. At the very least get peak flow checked as already suggested. That can be easily done by the asthma nurse. I believe there is a push for lung function to be reviewed for all ex smokers over a certain age but not sure if it is nationwide.

@rubyrubyrubyrubymurray Just updating after your kind advice. Finally iidentified one of his tablets as the source! Cough has gone completely. Glad its resolved but annoyed its taken us so long to be listened to!