Got a chronic cough?
What's causing that chronic cough, anyway? When doctors evaluate a complaint, they form a
"differential diagnosis", which is a list of possible diagnoses that should be ruled out.
Complaints of cough are most likely due to sinusitis or bronchitis, but can also be caused by
allergic drainage dripping down the throat. Sometimes, cough may be the only symptom we see
when we make the diagnosis of asthma (called 'cough-variant asthma'). Once in a while, gastro-
esophageal reflux presents as chronic dry cough. Many different medicines have cough as a
side effect, but ACE inhibitors, used to treat high blood pressure, are the worst offenders.
Names of some ACE inhibitors include Vasotec (enalapril), Prinivil or Zestril (lisinopril), and
Altace (ramipril).
Successful treatment of a cough depends on the underlying cause. I mentioned above that reflux
can present as cough. Sometimes, the cough is present in the total absence of heartburn.
Nevertheless, modifying the diet and taking one of the proton-pump inhibitors, such as Prilosec,
Prevacid, Nexium, Protonix or Aciphex can provide relief. When post nasal drip is a factor, we
can try antihistamines, anticholinergics and nasal steroids to get rid of the drip, thus decreasing
the cough. Often, though, the best way to stop the cough is by not coughing. Wait—that’s not as
stupid an idea as it sounds. The more you cough, the more you irritate your airways, making you
more susceptible to further cough. I often recommend that a combination of cough suppressants
be taken around the clock for a week or two to totally stop the cough.
What's causing that chronic cough, anyway? When doctors evaluate a complaint, they form a
"differential diagnosis", which is a list of possible diagnoses that should be ruled out.
Complaints of cough are most likely due to sinusitis or bronchitis, but can also be caused by
allergic drainage dripping down the throat. Sometimes, cough may be the only symptom we see
when we make the diagnosis of asthma (called 'cough-variant asthma'). Once in a while, gastro-
esophageal reflux presents as chronic dry cough. Many different medicines have cough as a
side effect, but ACE inhibitors, used to treat high blood pressure, are the worst offenders.
Names of some ACE inhibitors include Vasotec (enalapril), Prinivil or Zestril (lisinopril), and
Altace (ramipril).
Successful treatment of a cough depends on the underlying cause. I mentioned above that reflux
can present as cough. Sometimes, the cough is present in the total absence of heartburn.
Nevertheless, modifying the diet and taking one of the proton-pump inhibitors, such as Prilosec,
Prevacid, Nexium, Protonix or Aciphex can provide relief. When post nasal drip is a factor, we
can try antihistamines, anticholinergics and nasal steroids to get rid of the drip, thus decreasing
the cough. Often, though, the best way to stop the cough is by not coughing. Wait—that’s not as
stupid an idea as it sounds. The more you cough, the more you irritate your airways, making you
more susceptible to further cough. I often recommend that a combination of cough suppressants
be taken around the clock for a week or two to totally stop the cough.
Mercedes; call me a skeptic; diesel engines make
allergies worse.
With gasoline over $2.00 per gallon, automobile manufacturers are trying to figure out
how to let Americans have their cake, and eat it too. We want luxury, safety, and of
course, fuel efficiency. Honda, Ford, Lexus, GM and Toyota are bringing out hybrid
engines that run on both gasoline and electricity. Mercedes, on the other hand, is
featuring the diesel engine in its new E320CDI. Until now, Volkswagen had the only
diesel automobiles in American automobile showrooms. Most trucks are available with
diesel engines.
Diesel exhaust particles (DEPs) are terrible for people with allergies and asthma; to
tell you the truth, they even raise the allergic antibody (IgE) levels in people who do not
even have allergies. According to the Environmental Protection Agency (EPA), diesel
exhaust particles may be the component of air pollution most responsible for the huge
increase in allergies throughout the western world. The exhaust that these soot-filled
tailpipes release into your lungs make the immune system produce chemicals, called
cytokines, which worsen allergic inflammation. According to Mercedes, its new diesel
will be “clean”, burning its diesel fuel at higher temperatures and higher compression
ratios. This will “produce less noise and pollution” per Mercedes. As a recent Wall St
Journal article points out, though, the CDI is so new there are no emission statistics
available on the car. Meanwhile, cover articles from the Journal of Allergy & Clinical
Immunology from 2005 show diesel fumes driving production of IgE, the allergic
antibody.
Granted, diesels produce fewer greenhouse gases and are more fuel efficient than
their gasoline counterparts. But if you want to have your cake and eat it too, I
recommend a gasoline hybrid. Not a diesel. Not even a Mercedes diesel.
Nose Still Stuffy?
Poiseuille's Law (or, why Breathe Right® nasal strips are great stocking
stuffers)
I wrote in “An Army of Placebos” that doctors are often caught between a
rock and a hard place as we try to help our patients. The patient with the
stuffy nose who can’t take Sudafed because of high blood pressure is still
the example. That column failed to mention Breathe Right® nasal strips as a
helpful adjunctive treatment for stuffy nose. These adhesive strips stick to
the outside of your nose, and pull it open just a little bit to partially relieve
the congestion.
Poiseulle determined that the laminar flow rate of an incompressible fluid
along a pipe is proportional to the fourth power of the pipe's radius. In other
words, you need sixteen tubes to pass as much fluid as one tube twice their
diameter. In the case of the Breathe Right nasal strip, we’re not doubling the
radius of your nasal passage; just increasing it a bit. But consider the
example of a 7 mm passage that increases to 8 mm. 7 to the 4th power is
2401. 8 to the 4th power is 4096! In other words, you almost doubled the
amount of air that can flow through your congested nostril just by increasing
the diameter 1 millimeter. (The radius increased by 0.5 mm, Mrs. Brock,
from 3.5 mm to 4.0 mm).
Sorry for all that math, but I love to point out that staying awake in high
school physics class does have a point, after all. A few tips from veteran
users of Breathe Right nasal strips. First, the adhesive is good, but not
great. So clean the oil off your nose well before application so the adhesive
will stay put. Second, you need the strip sticky at its ends, but not in the
middle. Some patients put a little dab of Kleenex in the middle of the strip
before application so it doesn’t stick to the bridge of your nose. Then,
removing it doesn’t peel off your skin. Ouch!
| The Allergy Clinic Specialists in Allergy & Asthma Care |
If you love cats, but you’re allergic to them, hope may be on the way. The major protein responsible for cat allergen has
long been known: it is called Fel d I. It is found in the dander of the cat after being produced in the cat’s sebaceous
glands. The gene responsible for producing Fel d I has been identified, and a company called Allerca has bred kittens
after silencing this gene. Kittens were available for purchase for $4,000.00, but demand drove the price up to $5,950.00.
With an additional $2,000.00 fee if you wanted to go to the top of the waiting list. But they have sold too many kittens, and
have now stopped selling them until their own supply is replenished.
If you wish to spend less money than that, or keep your current kitty, but Whiskers is driving your allergies nuts, here’s
some advice:
First off, it is always best to remove the cat from the allergic person’s home. Having said that, most patients I counsel
want to reserve cat relocation as the last option. I’m OK with that as long as the cat is not sending you to the E.R. with
brittle asthma. So, assuming Fluffy will not be evicted, here’s what may help:
1. Keep the cat out of your bedroom at all times, even when you’re not home.
2. Remove carpeting from your bedroom (removal from the whole house is even better)
3. Cover your mattress and pillow with true allergy-proof covers. My favorites are from Mission Allergy . They’ll give you a
15% discount on pillow and mattress barriers if you ask nicely and say we referred you.
4. Put a H.E.P.A. filter in your bedroom and run it 24/7. I usually don’t recommend fancy filters; that’s because most
allergens are heavier than air. Cat allergen is tiny and remains airborne; thus, it can actually be captured by a good filter.
5. Mild or moderate cat allergy responds very well to allergy shots. Allergy Shots, when administered correctly, actually
induce tolerance in the allergic patients so that future encounters with cats produce milder symptoms.
6. Consider getting a light-colored, neutered cat. Some researchers believe they produce less Fel d I than their darker
cousins. A black male cat, therefore, may be a bad choice for the allergic patient.
7. If you play with your cat, wash your hands well and change shirts afterwards. Take care not to touch your eyes.
Removing a cherished member of the family from the home can be difficult. Often, we are able to bridge the gap between
a cat lover and their cat allergy.
long been known: it is called Fel d I. It is found in the dander of the cat after being produced in the cat’s sebaceous
glands. The gene responsible for producing Fel d I has been identified, and a company called Allerca has bred kittens
after silencing this gene. Kittens were available for purchase for $4,000.00, but demand drove the price up to $5,950.00.
With an additional $2,000.00 fee if you wanted to go to the top of the waiting list. But they have sold too many kittens, and
have now stopped selling them until their own supply is replenished.
If you wish to spend less money than that, or keep your current kitty, but Whiskers is driving your allergies nuts, here’s
some advice:
First off, it is always best to remove the cat from the allergic person’s home. Having said that, most patients I counsel
want to reserve cat relocation as the last option. I’m OK with that as long as the cat is not sending you to the E.R. with
brittle asthma. So, assuming Fluffy will not be evicted, here’s what may help:
1. Keep the cat out of your bedroom at all times, even when you’re not home.
2. Remove carpeting from your bedroom (removal from the whole house is even better)
3. Cover your mattress and pillow with true allergy-proof covers. My favorites are from Mission Allergy . They’ll give you a
15% discount on pillow and mattress barriers if you ask nicely and say we referred you.
4. Put a H.E.P.A. filter in your bedroom and run it 24/7. I usually don’t recommend fancy filters; that’s because most
allergens are heavier than air. Cat allergen is tiny and remains airborne; thus, it can actually be captured by a good filter.
5. Mild or moderate cat allergy responds very well to allergy shots. Allergy Shots, when administered correctly, actually
induce tolerance in the allergic patients so that future encounters with cats produce milder symptoms.
6. Consider getting a light-colored, neutered cat. Some researchers believe they produce less Fel d I than their darker
cousins. A black male cat, therefore, may be a bad choice for the allergic patient.
7. If you play with your cat, wash your hands well and change shirts afterwards. Take care not to touch your eyes.
Removing a cherished member of the family from the home can be difficult. Often, we are able to bridge the gap between
a cat lover and their cat allergy.
| And You're a Cat Lover? |
