A Curious Cough

She took a few sips from her water glass to quell the cough, but this seemed to make it worse. Her embarrassment evident, she excused herself and sought refuge in the ladies room. The spell continued for a few more minutes in explosive, uncontrollable bursts. She eventually composed herself and returned to join her friends. As expected, the focus of the conversation shifted to her. Her friends wanted to know how long she had been ill. What was wrong with her? Did she have a pneumonia, TB perhaps, or lung cancer?!! Had she used anything for the cough? Had she seen her doctor? She told them that she had used every cough medicine in her pharmacy. All they had done was to make her drowsy. At least she did not cough while she was asleep. Her friends gave her all of their home remedies, and she promised to try all of them.

On her way home, Jennifer reflected over the last 6 months. When it started, her cough was barely noticeable, a minor irritation. With time, it became more persistent, occurring mostly at night. On occasion, similar episodes to the one in the restaurant had occurred, with an uncontrollable fit of coughing that would not go away. She had seen her doctor a few weeks after the cough started. He had told her that she had bronchitis and prescribed a 5 day course of antibiotics. It may have helped a little, but really not that much.

She decided that she had to see her doctor again, because something was definitely wrong. He examined her and found that her lungs were clear, as it was on the first examination. This time, he also performed a pulmonary function test which measured the amount of air she was able to expel from her lungs. The test was repeated after a breathing treatment with a medicine called Albuterol. He found that the amount of air she was able to expel from the lungs improved substantially after the treatment.

The doctor told her that her results indicated that her cough was caused by asthma. He gave her a prescription for an Albuterol inhaler that he told her to use if she had any cough, wheezing or shortness of breath. He also gave her another prescription for a steroid inhaler that she should use on a regular basis, whether she had symptoms or not. He gave her a written asthma action plan and asked her to come back to see him in a few weeks so that he could asses her progress. She was still concerned. How did she develop asthma? Could she be cured? He explained that asthma resulted from an interplay between genetic and environmental factors. Some individuals tend to produce higher levels of a chemical called IgE which is associated with hay fever, eczema and asthma. Environmental factors, such as dust, animal hair (e.g. dogs and cats), insects (cockroaches are notorious), respiratory infections, mold, air pollution, cigarette smoke, exercise and certain chemicals can trigger asthma. These factors resulted in the release of different chemicals in the body which caused narrowing of the air passages as well as increase in mucus production in the lungs. This resulted in difficulty breathing (sometimes described as chest tightness), as well as wheezing (the high pitched sound caused by airflow through narrowed airways). He also told her that asthma does not have a cure, per se, but that it can be controlled by avoiding asthma triggers and taking her medicines as prescribed. He also demonstrated how she should use her inhaler. He told her that she should first shake the inhaler, remove the cap and exhale. She should then put the inhaler in her mouth, inhaling deeply. She should hold her breath for a count of ten and then exhale slowly. He asked her to remember to rinse her mouth after using the inhalers to reduce her chances of developing a yeast infection. She had one final question: how come she never wheezed. She thought that all asthmatics wheezed. He explained that she could be wheezing during her coughing episodes at night, but she just has not be able to hear it. He further explained that some people with asthma do not wheeze at all.

When she went home, she immediately called her mother. She told him what the doctor said. Her mother told her that she had eczema as a child and that for a while, she had had frequent episodes of ‘chest colds’ with wheezing.

Four weeks later, she went for her follow up with her doctor. Her coughing episodes were much less frequent, and she was able to sleep much better at night (without cough medicines). He asked her to avoid all the known triggers of her cough and he would attempt to discontinue the steroid inhaler at her next visit. She should keep her Albuterol inhaler at all times in case something triggers her asthma unexpectedly.

On her way out of the doctor’s office, she called Simone. She had some great news, could she do lunch?