persistent cough, best treatment in bangkok

[infinity11]

thai gal has had a cough for a long time
she already went to a local clinic
came away with a ton of medications and it got better for a while
but now it is back

so what are the options?
and how about the cost to see the best specialist?
and who is the best?

she has been avoiding the doctor and i MUST see her do something to address it

i had something like it, walking pneumonia, that was easy to treat but we do not know the problem exactly yet

[thepool]

Where are you ?

Any chest physician (Pulmonologist) will be able to treat her.

She needs evaluating and a chest x-ray to begin with .

edit

spelling

Edited April 16, 2014 by thepool

[Loaded]

asthmatics often have a dry tickly cough. I get one, usually after a virus, and it sometimes leads to an asthma attach if I don't treat. I use an inhaler such as symbicort.

[Sheryl]

Would help to know a little more, such as:

- Is it a dry cough or productive (phlegm)?

- Any fevers? Weight loss?

-Has a chest xray been done? results?

And where is she located.

Cost for private consultation with a specialist varies greatly by hospital, part of the country and doctor. Also by what tests are needed. But very roughly, anywhere from 1,000 - 3,000 baht inclusive. If she has already had a chest Xray that was normal, please specify this as it makes a big difference. Ditto a blood count.

The main issue here is whether she needs to be screened for possible TB/other pulmonary infection, in which case she needs a pulmonary specialist, or whether this is likely to be due to post-nasal drip and allergic in origin in which case an ENT is best. So please do elaborate.

[infinity11]

i dont think asthma or allergies but ...

mostly dry cough but she is getting colds too, on and off, now back on

i think she needs blood work and someone to listen to her lungs and THEN maybe an x-ray

location: huay kwang or something to that affect

i hope this helps and i am not leaving too much else out

thanks for your help and support, i want to see her well again!

[Sheryl]

Suggest Dr. Phichai Namsirikul at St Louis Hospital on Sathorn (Surtasak BTS stop)

Monday :: 09:00 AM - 12:00 PM
Wednesday :: 09:00 AM - 03:00 PM
Saturday :: 09:00 AM - 12:00 PM

She should have a chest Xray to rule out TB, it is not possible to do that just by physical examination. Only costs a few hundred baht.

Go with her and if the doctor does not suggest Xray, politely ask " Since she has had a chronic cough for a long time now, would it wise to get an Xray just to rule out TB?".

[ezzra]

These are a must

1. full blood work, to determent is any thing wrong there,

2. followed by chest Xray or CT scan

See a good GP first and will get a referral to the appropriate specialist at any reputable hospital

in Bkk, forget about the local clinics, they're useless and they act ad drugs dispenses..

[infinity11]

yep local clinic was a waste thanks all

update she had a chest x ray with nothing wrong

i told her she needs blood work up

Edited April 17, 2014 by infinity11

[ebean001]

Dr Surasit Sakrasae at Ram Hospital in Chiang Mai was the most intelligent doctor I have ever talked to. he is a pulmonologist

[Sheryl]

OP is in Bangkok

If she had a normal CXR recently that ups the odds that the cough is due to irritation from post-nasal drip which in turn may be allergic in origin.

Actually if no fever, no abnormal lung sounds on auscultation and with a negative CXR a CBC (blood test) may not be indicated.

You can start with the pulmonologist but if he doesn't find anything (as I suspect he may not) then see ENT, Prof. Songklot at same hospital.

[atyclb]

Sheryly with good input as usual.

I recall asthma being the most common cause for chronic cough. it is commonly undiagnosed and asthma symptoms can be very light without the distress and shortness of breath it is known for.

While getting to a physician for a work up it would not hurt to try an albuterol or salbutamol inhaler. Keep in mind proper technique for use of inhaler is crucial. Many people dont use right and see no benefit. Alternately if the inhaler technique is an issue Ventolin tablets are an option. Thailand has 2 mg ventolin tabs or generic. Bets not to give more detailed suggestion on internet. Pharmacist will / should know starting dose. Symbicort inhaler is NOT a rescue inhaler.

as the op said the "bunch of medications" made the cough get better it may be she requires chronic medication (asthma as one example)

smoking or second hand smoke?

Edited April 17, 2014 by atyclb

[ThaiMouse]

Just do a tuberculin skin test. Simple safe and reliable. Then if positive do the xray and blood work up rountine etc?

[Guitar God]

Another possibility is gastric reflux (GERD). The usual symptoms are "heartburn" or acid indigestion but it can also cause excessive mucus production in the lungs resulting in a cough.

Does she smoke cigarettes? Chemicals added to the tobacco during the manufacturing process suppress the cough reflex and reduce the activity of the cillia which normally clear out the lungs.

I saw a specialist at Mankutwattana hospital and the bill including lab tests was under ฿2500.

A visit to an ENT should either find the cause or at least eliminate some possibilities.

[Sheryl]

Tuberculin skin test is less useful in Thailand since BCG immunization is routinely given. And, she has had a negative CXR, so pulmonary TB is pretty well ruled out as a cause.

I would advise against taking anti-asthmatics of any sort unless diagnosed as having asthma. What has been described thus far sounds much more like irritation from chronic post-nasal drip than asthma. This is a very, very common problem in Bangkok due to the air pollution.

[ggt]

It may be as simple as being allergic to the air pollution...dust...pollen...smoke...and so on...

Some people experience a reaction to the overload of pollutants which cause them to produce mucus in their sinus cavities...

This mucus fills up the sinus...then starts draining down the throat...tickling the throat...causing the persistent cough...

If not treated...could lead to asthma...bronchitis...or even pneumonia...

I use 50 mg Meptin...take 1/2 morning and night...keeps my lungs clear of mucus...ask your doctor or pharmacy...

Hope this helps...

Edited April 17, 2014 by ggt

[atyclb]

Tuberculin skin test is less useful in Thailand since BCG immunization is routinely given. And, she has had a negative CXR, so pulmonary TB is pretty well ruled out as a cause.

I would advise against taking anti-asthmatics of any sort unless diagnosed as having asthma. What has been described thus far sounds much more like irritation from chronic post-nasal drip than asthma. This is a very, very common problem in Bangkok due to the air pollution.

I've reviewed the OP's 3 posts. Please explain you argument pro post nasal drip versus RAD.

Since when would an albuterol inhaler trial be a no no?

[LPCustom69]

Has anyone checked the air conditioner filter? It's not checked by a lot of people here.

[bushwacker]

Hmmm ... best option .... go back to the doctor!

(these questions are getting harder and harder to answer ... soon they will be beyond me!)

[Shurup]

I have a frequent cough too, usually after meals if I eat something very spicy, and I love spicy! Even when I'm not in Thailand, I try to find some chili peppers and chew on them with my meals.

Normally shortly after meal the cough will start, at first it feels like a dry cough but it gets better and I have some mucus coughing up. It may last up to a few hours after meal. Is it GERD that @Guitar God has mentioned? I do have heartburns on and off which can happen daily up to a month and then go away for up to a few months, sometimes it's just weeks or days though... I normally don't take any meds for hearburns.

Edited April 17, 2014 by Shurup

[Winniej]

Get it seen to . A bloke that works for us has had a bad cough for 15 years . He reckons it is just a cold that won't go away .

[atyclb]

I have a frequent cough too, usually after meals if I eat something very spicy, and I love spicy! Even when I'm not in Thailand, I try to find some chili peppers and chew on them with my meals.

Normally shortly after meal the cough will start, at first it feels like a dry cough but it gets better and I have some mucus coughing up. It may last up to a few hours after meal. Is it GERD that @Guitar God has mentioned? I do have heartburns on and off which can happen daily up to a month and then go away for up to a few months, sometimes it's just weeks or days though... I normally don't take any meds for hearburns.

Persistent recurrent heartburn as in GERD can cause per-cancerous changes to the esophagus. Look up Barretts esophagus. Nothing to play around with nor be taken lightly.

[atyclb]

It may be as simple as being allergic to the air pollution...dust...pollen...smoke...and so on...

Some people experience a reaction to the overload of pollutants which cause them to produce mucus in their sinus cavities...

This mucus fills up the sinus...then starts draining down the throat...tickling the throat...causing the persistent cough...

If not treated...could lead to asthma...bronchitis...or even pneumonia...

I use 50 mg Meptin...take 1/2 morning and night...keeps my lungs clear of mucus...ask your doctor or pharmacy...

Hope this helps...

meptin is procaterol, a bronchodilator similar to albuterol. it would open the passageways in the lungs and help mobilize secretions.

[djvolak]

Has anyone checked the air conditioner filter? It's not checked by a lot of people here.

You beat me to it. I have to do ours all the time. My wife is coughing like the OP's girl too. Trying to get her to hospital is like pulling teeth.....

[h90]

asthmatics often have a dry tickly cough. I get one, usually after a virus, and it sometimes leads to an asthma attach if I don't treat. I use an inhaler such as symbicort.

could be also allergic....

[renaissanc]

If you have lots of time and money for tests, x-rays, examinations, pills, creams, and cough mixtures, then follow the traditional medical path. But if you want to cure the problem yourself without any expense and without going anywhere, and you are open-minded, rectify the problem being experienced with the solar plexus chakra. It controls the throat in the endocrine system. You'll find plenty of ways to look after this energy centre on Google.

As for me, if I have a sprain or some ache or something, I do some chakra healing, send healing energy to the spot in the form of light, or I use the energy from old trees. You'd be amazed at what you can cure in these 3 ways alone. As for old trees, the energy they send you is amazing!

[430xc]

How old is this lady? Is she taking any medications? Some medications (especially ACE inhibitors for high blood pressure) can cause a persistent dry cough. But it is good to follow-up and find the cause and not just throw potent and possibly risky medications at the problem hoping to get a diagnosis and fix.

[Norfolk Fox]

Any persistent cough lasting more than three weeks should be taken very seriously. Blood tests and a chest x-ray are a must and are standard procedure with GP's in the UK. In the majority of cases the outcome is not serious and and relatively simple treatment will cure it.However, it is sometimes an indication of something sinister which needs urgent treatment. Do not ignore it or mess about self-medicating.

[thepool]

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If you have lots of time and money for tests, x-rays, examinations, pills, creams, and cough mixtures, then follow the traditional medical path. But if you want to cure the problem yourself without any expense and without going anywhere, and you are open-minded, rectify the problem being experienced with the solar plexus chakra. It controls the throat in the endocrine system. You'll find plenty of ways to look after this energy centre on Google.

As for me, if I have a sprain or some ache or something, I do some chakra healing, send healing energy to the spot in the form of light, or I use the energy from old trees. You'd be amazed at what you can cure in these 3 ways alone. As for old trees, the energy they send you is amazing!

Dangerous and disingenuous advice !

Do not advise others to adopt Quackery !

[infinity11]

Sheryly with good input as usual.

I recall asthma being the most common cause for chronic cough. it is commonly undiagnosed and asthma symptoms can be very light without the distress and shortness of breath it is known for.

While getting to a physician for a work up it would not hurt to try an albuterol or salbutamol inhaler. Keep in mind proper technique for use of inhaler is crucial. Many people dont use right and see no benefit. Alternately if the inhaler technique is an issue Ventolin tablets are an option. Thailand has 2 mg ventolin tabs or generic. Bets not to give more detailed suggestion on internet. Pharmacist will / should know starting dose. Symbicort inhaler is NOT a rescue inhaler.

as the op said the "bunch of medications" made the cough get better it may be she requires chronic medication (asthma as one example)

smoking or second hand smoke?

no smoking no 2nd hand either

[infinity11]

Hmmm ... best option .... go back to the doctor!

(these questions are getting harder and harder to answer ... soon they will be beyond me!)

yep

she went back yesterday for xr and second treatment

and will do follow up after 7 day anti biotic with other meds

we are now thinking about traditional Chinese medicine in bangkok