Persistent Chronic Cough

My dad is 82 years old and started on PD last August (2007); we have been learning a lot as he has continued with his treatment. We have talked with his doctor about a persistent chronic cough that began when he started PD; his doctor says that he has checked with his colleagues and has not found any PD patients who suffer from this ailment.

Have any of you heard of this symptom being linked with PD? My dad buys huge boxes of cough drops to deter the cough and, as a result, food doesn’t taste good to him anymore and he has that cough drop aftertaste in his mouth all the time. The coughing even keeps him up at nights. The only time he can be guaranteed relief is when he sits very far forward in a chair. We had thought that maybe it was the location of the dialysate in his abdomen that was irritating his diaphragm and causing the cough. He has seen a pulmonary doctor who can’t find any physiological reason for the cough in his lungs; his heart is in perfect condition for his age; his ENT finds nothing wrong. It’s very frustrating to my dad and is affecting his quality of life.

Thank you!

Hi Greeneyesinva,

A persistent cough can certainly be seriously annoying. Other than his catheter somehow irritating a nerve, is your dad possibly taking a blood pressure pill in the ACE-inhibitor class? The generic names of these drugs end in “pril” (captopril, ramipril, etc.). Persistent cough is a very common side effect of ACE-inhibitors, and if he is on one, a switch to another type of BP pill (often an ARB) is definitely worth a try. Sometimes BP drugs in the beta-blocker class can also cause a cough.

In the only article I could find about persistent cough and PD, such a cough is 3x more likely on PD than on HD. Other reasons for a cough could include gastro-esophogeal reflux disease (GERD). The need to sit far forward might suggest this, and so does the food not tasting good. (Stomach acid can burn his throat). Does your dad have any heartburn? Perhaps the presence of the PD fluid is causing reflux of his food, which can lead to a cough. There are a number of treatments for reflux.

Hi greeneyesinva, Dori,

Interesting ye should bring this topic up. My wife - who is on PD - baxter Machine, has also got this cough. AND SHE is on Ramipril. She was on quiet a few BP drugs up to recently and her BP has improved hugely. So now she is down to just Ramipril ( on advice from consultants by the way ). BUT even now she has stopped taking the Ramipril - this because her BP was going down low and she was getting dizzy. Now on no BP drug she is fine BP wise.

We were with her consultant for an hour yesterday, he congratulated her and said this was the correct action, monitor the BP and if it begins to go up - go back on the Ramipril again.

We were also at her GP last week who like you Dori said that the Ramipril could be causing the cough. The consultant admitted this too, that this was possible.

Her heart, lungs, etc were all checked by both - all fine.

Hope this also helps and confirms,
Aidan

Hi, Dori and carodriscoll,

Thank you for your input; really appreciate it. I talk with my dad everyday (he is located about 70 miles from me) and mentioned this to him last night. While he did have high BP for years (this being the assumed cause of his renal failure now) before going on PD, he doesn’t anymore–in fact, he is suffering from hypotension now and his nephrologist prescribed medrodine hydrochloride (to even out his BP as daily he has readings as low as 74/49).

I asked him if he was on any other new drugs that might have that suffix and he is not; he ran through all of them with me on the phone. It had been suggested a couple of months ago by his gastro dr. and FD that he might have GERD; he tried Prilosec and it gave him side effects but no relief from the cough. So that has been checked off the list as not the problem.

None of his medical providers seem to know; he does have an appointment next week with a pulmonary dr. to discuss CT scan results that he had done a couple of weeks ago. That dr. called yesterday and said that he sees a shadow at the base of the lungs and wants to do an endoscopy to determine if it is a chronic infection, fluid or a fibroid-type mass. He did not think any of this would be the cause of the cough though.

It’s just the strangest thing…Thank you, again, though for your ideas!!

Hey Greeneyesinva,

Is your dad on any BP drug? Maybe if you mention all of the drugs ( not just BP ones ) he is on here others like Dori with the knowledge may identify or have heard coughing as a symptom OF these drugs. Just a thought,

Might be unrelated and not sure if this causes low BP ( over to Dori ) - but my wife had issues with the parathyroid also and was on some drug for same …

Aidan

Hi, Aidan:

Thanks. The only BP meds he is on is the one I mentioned and that is to try to balance out his BP due to hypotension. That is medrodine hydrochloride; he can only take 1/2 dose daily due to experiencing sweats, chills, nausea, and dizziness. Also, it prevents him from urinating at all. We will be seeing his dr. next week; he only sees the doctor every other month and talks with the nurse or sees her on the alternating months. He gets an injection of Aranesp every 10 days, I believe, and is on two 4.25% and two 2.5% bags of dialysate everyday.

He has some other dialysis related issues as well that we are trying to deal with. Wish we had known about this web site before going into PD…you guys are great!! We really did not get the education we should have, but not for lack of asking questions–just not the right ones!! :slight_smile:

Will try to get a list of all my dad’s meds and see if any might be causing the cough.

Thanks, again, and have a great day!!

Eileen

Hi Eileen,

I looked up midrodine hydrochloride (proamatine), and cough is not listed as a side effect. Checking out what is going on with your dad’s lungs is certainly a good idea. If Prilosec didn’t work for GERD, there are also other treatment options. Some people get relief just by raising up the head of the bed by an inch or so (putting blocks under the bed legs), which doesn’t even involve any medication.

Dear Dori,

Thank you for all your research. He actually said that at night the only thing that brings relief is hanging his head over the side of the bed; that seems to ease up the cough and allow him to get to sleep. He says that he does not have acid reflux or heartburn. Perhaps the answer will come next week when he sees the pulmonary dr.

I saw the web site that sponsors this msg board and thought I would try to see if I could come up with anything for him re: the cough. He has other issues that seem to be related to the PD that we plan to discuss with the nephrologist next week, too.

Meanwhile, I am going to read the msg board for PD here and see what else I can learn. I have already seen symptoms that he has posted by others here; there is some comfort in knowing that others are also going through the same things!

Thank you, again.

Eileen

Oh, gosh, I really hope so–this does not sound like a “normal” cough, and it’s pretty clear why it would reduce his quality of life. Wikipedia has a very good article about coughing that might help trigger some more ideas about what’s going on: http://en.wikipedia.org/wiki/Cough.

I coughed and coughed AND COUGHED prior to being diagnosed with ESRD. When I was not dialysis enough…(trying to “learn” what worked best for me ) the cough continued. I thought I coughted from allergies…One of the symptoms of “fluid overload” is coughing?? I always coughed worse at night…but it was TERRIBLE. Hope you find what is going on and can “fix” it…It’s miserable to cough non stop!

Thank you so much for this information. We are going to see my dad’s nephrologist today and I will ask about this…we have a TON of questions to discuss, but I’m from the “North” so I can talk very fast!! :slight_smile:

Everyone have a GREAT day and I will let you know what I find out.

Eileen

This may be off-the-wall, but I wonder if his cough could be worse because of the particular brand of cough drops that he’s taking. I’ve found that certain ones make me cough more instead of less. It sounds like he may be sucking them more often than the package says. If so, it might be worth trying another cough drop and/or trying to cut back on how many he uses per day.

BTW, a study of cough in PD found that 43% of patients with GERD denied having heartburn or a sour taste in their mouths so it might be worthwhile having tests to rule out GERD.

Other possible causes besides GERD, ACE inhibitors and beta blockers and too little fluid removal include:
– pulmonary edema
– congestive heart failure (CHF)
– post-nasal drip
– asthma
– chronic obstructive pulmonary disease (COPD)

Hope the tests on his lung help with diagnosing and treating his cough even though the doctor says it shouldn’t make any difference.

[QUOTE=Beth Witten MSW ACSW;16214]This may be off-the-wall, but I wonder if his cough could be worse because of the particular brand of cough drops that he’s taking. I’ve found that certain ones make me cough more instead of less. It sounds like he may be sucking them more often than the package says. If so, it might be worth trying another cough drop and/or trying to cut back on how many he uses per day.

BTW, a study of cough in PD found that 43% of patients with GERD denied having heartburn or a sour taste in their mouths so it might be worthwhile having tests to rule out GERD.

Other possible causes besides GERD, ACE inhibitors and beta blockers and too little fluid removal include:
– pulmonary edema
– congestive heart failure (CHF)
– post-nasal drip
– asthma
– chronic obstructive pulmonary disease (COPD)

Hope the tests on his lung help with diagnosing and treating his cough even though the doctor says it shouldn’t make any difference.[/QUOTE]

Beth,

In talking with my dad last night, he indicated that he is definitely using more cough drops per hour than the package advises but not for the day. He believes that post-nasal drip definitely plays into the cough but has none of the other issues you listed. I am not sure if any actual testing has been done for GERD and will suggest that to him; he just got suggested diagnoses from doctors he has recently seen. Prilosec did nothing for him…

Thank you so much for your research and help!

Eileen

Has he told the doctor about his post-nasal drip. If not, there may be things to do to diagnose and treat the cause and/or symptoms.

Has he tried different cough drops? It might be worth trying different ones for a few days at a time to see if something different works better. The pharmacist may be able to recommend something.

Here’s more information from the American Academy of Family Physicians on diagnosis and treatment of GERD. It’s possible that some of the lifestyle or dietary changes or one of the other drugs mentioned in this article could help if he has GERD. This article might help to come up with questions to discuss with his doctor.
http://www.aafp.org/afp/990301ap/1161.html