Post-surgery cough

DEAR DR. ROACH: A year ago, I had cardiac bypass surgery. Everything went great: I had no pain.

In a sense, it didn’t even feel like any surgery took place, except for the incision and drainage tubes, which were a good physical reminder.

About a day or two after getting home, I started coughing. I would cough and cough and cough. It started when I would lie down, and sitting up initially helped.

Later, I was coughing all the time. Cough drops or syrup didn’t help. The doctors could not find any fluid around my heart, or anything out of the ordinary.

To make a long story short, my doctor prescribed a short course of steroids and then benzonatate, which was the only thing that would stop my cough.

I still cough occasionally, but nothing like it was. What would have caused a post-surgical cough?

ANSWER: There are many possible causes for cough after surgery. During surgery, a plastic tube is inserted into your airway so the machine can breathe for you: This can cause irritation, and is a frequent cause for cough. (That usually lasts only a few days.) Fluid overload can also do it. Infection in the lung is probably the biggest concern. Often, medications that are started after surgery, especially ACE inhibitors (their generic name ends in “-pril,” like “lisinopril”), cause cough after being on them a short while.

The nerve to the diaphragm, the phrenic nerve, can be damaged or irritated during surgery, causing a cough that might last for months.

Benzonatate is a non-specific cough remedy: It is modestly effective at suppressing cough of any type. The short course of steroids makes me wonder if there was a suspicion for reactive airway disease (on the asthma spectrum).

Some people without any history of asthma still may have some asthma symptoms, especially cough, after surgery.