I’ve had a niggling cough for 20 years
I’VE had a cough for at least 20 years. My previous GP said I probably had asthma and prescribed an inhaler, but it didn’t help. My new GP says I probably don’t have asthma, but silent reflux. How can I get a definitive diagnosis? Kirstine Jackson, Sheffield.
Twenty years ago doctors began to realise that a persistent, irritating cough could be a symptom of asthma, even if it wasn’t accompanied by the wheezing typically associated with it.
this led to more asthma diagnoses and more prescriptions for inhalers, usually a combination of a drug to relax the walls of the airways and another to combat inflammation.
But I agree that if your cough was really due to asthma, the inhaler would probably have suppressed it to some extent. I also agree that silent reflux of acid from your stomach is a possible cause of your symptoms.
Let me explain: previously, we thought the only consequence of acid reflux (where the valve at the bottom of the oesophagus — gullet — doesn’t work properly, causing stomach acid to splash up) was heartburn or a sensation of regurgitation.
But over the past decade it’s emerged that acid reflux can contribute to a number of symptoms and problems.
these include tooth erosion, chronic rhinitis (inflammation of the nose, causing it to become blocked or runny) and in children even glue ear, because refluxed acid can potentially reach into all these areas.
Another serious problem is Barrett’s oesophagus, where acid causes the cells lining the gullet to become like the cells lining the stomach. It is a pre-malignant condition, i.e., it has the potential to become cancerous. Acid reflux can also lead to cancer of the voice box.
But apart from heartburn, perhaps the most common consequence is a cough, which can develop as a result of the acid irritating the throat. to confirm that the cough is due to acid reflux, doctors will typically prescribe a drug known as a proton pump inhibitor (or PPI), which suppresses the secretion of acid by the stomach.
If the symptoms ease, it’s likely to be an acid reflux cough. B ut a PPI doesn’t always eradicate the symptoms. For a more precise diagnosis, it is better to examine the oesophagus with a series of tests.
these include a barium swallow X-ray (barium sulphate shows up on X-ray and allows the doctor to see if you are experiencing reflux) and an upper gastrointestinal endoscopy (where a camera is used to examine the lining of the throat and gullet).
Oesophageal function studies are another option. these check whether the valve at the bottom of the gullet is working properly, for example by measuring acidity in the gullet.
your GP can refer you to a gastroenterologist for tests. As you have had this cough for 20 years I can’t stress how important it is to reach a proper diagnosis rather than trialling a treatment based on symptoms alone. A SURGEON has told me there is a build-up of calcium in my left leg and having a ‘balloon’ fitted could help. But he was so negative I decided not to have it. What are the implications of getting it done or not? I am 79. Barbara Hecken, Gosport, Hants. From what you tell me, I gather you have peripheral vascular disease, where blood flow to the legs is reduced by fatty deposits known as plaques forming under the lining of the arteries.
the condition is associated with smoking, diabetes, high cholesterol and high blood pressure — the same risk factors that can lead to coronary artery disease (but with the latter, the plaques form in the arteries supplying the heart).
Over time these plaques calcify, turning chalky. your specialist will have spotted this when a test (probably an ultrasound scan) was carried out to investigate. you probably had leg pain that got worse when walking and eased at rest (a symptom called intermittent ‘claudication’).
the treatment you have been offered is balloon angioplasty. Carried out under local anaesthetic, this is where a specialist threads a slender tube called a catheter down the artery via an incision in the groin.
A balloon is then inflated at the site of the blockage to squash the obstruction away before a stent (a tiny tube) is inserted to hold the artery open and improve blood flow.
It’s unclear why your surgeon was negative about this procedure. But patients who have the best results are those under 70, who don’t have diabetes and whose arteries are affected only above the knees.
And the technique is used for only small blockages; larger obstructions are better treated with surgery to bypass the narrowed section with a graft. It may be that your surgeon wanted you to try to improve the blood flow without angioplasty or surgery. Stopping smoking, and controlling diabetes, high cholesterol levels and high blood pressure can all help, as can daily exercise. the advice is to ‘walk through the pain’ — to keep going as long as possible, as it encourages collateral vessels (new blood vessels). you may have also been prescribed a daily aspirin to stop blood clots forming.
with all these steps, it may be possible for you to avoid balloon angioplasty. But if your condition gets worse you may develop pain in the legs even when at rest. If this happens, some kind of procedure will be necessary.