From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Help with cough
Date: 14 Mar 1999 08:15:53 GMT

In <36EB372E.2873D32A@servtech.com> Ed Mathes <emathes@servtech.com>
writes:

>We have been seeing a cough that is lasting up to 6 weeks.  It usually
>begins with a viral URI that abates but the cough persists.  "I cough so
>hard I_______"....take your pick..."pass out"; "pee my pants", "broke a
>rib"; "throw up".
>
>After workup, the cough is usually controlled with suppressants until it
>resolves on it's own.
>
>Any cough that lasts more than 4 weeks deserves a throough
>evaluation.....bask lab tests, chest x-ray, spirometry, whatever it takes
>to pinpoint the cause.  The list is long...Infections (viral or bacterial,
>TB, pertussis), bronchospasm (either transient as in Reactive Airway or
>Asthma), reflux, post-nasal drip, malignancy.  These are the most common
>causes.  I had one case of thymoma present as sough and a thyroid goiter
>un-noticed by the patient who came in complaining of cough.
>
>Hoe this helps.
>
>
>--
>Edward J. Mathes, RPA-C
>N2RQO
>Internal Medicine
>emathes@servtech.com



    We wait a little longer in geriatrics for lower respiratory tract
symptoms to clear after a typical viral-type infection, so long as lung
exam is normal (save perhaps for increased expiratory breath sounds),
oxygenation is good, and cough is unproductive.  We've been seeing a
fair amount of what you have.  In early stages the tacycardia is all
out of proportion to the other stuff, and the chest X-rays are as clear
as the exam.  Part of a mini-epidemic of parainfluenza, I believe.  Rx
is symptomatic.

                                           Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Help with cough
Date: 14 Mar 1999 08:18:21 GMT

In <36EB35AB.217644C1@servtech.com> Ed Mathes <emathes@servtech.com>
writes:

>Al wrote:
>
>> A medication that will stop the coughing in less than 30 minutes is
>> Tussionex. Comes in a sweet syrup. Because it is listed as a narcotic,
>> docs are reluctant to prescribe it. Nothing better for short term
>> (several hours) relief.
>
>Who'se reluctant to prescribe it? Just because it contains a narcotic?
>And not enough to "cause addiction". The active ingredient is
>hydrocodone. I have also prescribed 1/2 tab Tylenol #3 for cough. If they
>use it in conjunction with OTC Robitussin...instant Robitussin AC at half
>the cost.


   Yep.  I prescribe that myself.  And for those who are really cheap,
you just take half a Tylenol #3 (or a whole one at night) and skip the
Robitussin.  This often works well enough.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Help with cough
Date: 14 Mar 1999 08:21:59 GMT

In <36EB349D.85EB67C1@servtech.com> Ed Mathes <emathes@servtech.com>
writes:

>Our local health department advised us late last year that any adult
>over 50 with a "tickle" type cough tht lasted more than 3 weeks may
>have pertussis.


  I've had my acellular DPT booster.  Slightly sore deltoid, but that
was it.  Can't seen to convince my partners to do it, and am not about
to routinely give it to my patients before some official recommendation
comes out.  But I have a feeling they'll all eventually be sorry.

                                        Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Help with cough
Date: 16 Mar 1999 07:37:53 GMT

In <36EDB853.5F01@gate.net> Al <forman@gate.net> writes:

>Did either of you two read Torgo's history of his wife's cough? If you
>did and you still think a half Tylenol #3 is both adequate and
>appropriate for her condition, I am amazed at your optimism.


    You never know till you try.  The antitussive effect of codeine is
somewhat out of proportion to its narcotic/analgesic effect.  And you
can always ADD other stuff if it doesn't work.  Cheaper to do it that
way than buy proprietary mixes, especially syrups.