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Lung diseases

Cough Syncope

04/20/2006

Question:

My husband (55 years old) has had a chronic cough for over five years that has progressed into cough syncope which can occur 1-5 times per day or 1-5 times per week. Once he collapsed hit his head on the floor and ended up with 16 stiches. Some days he can cough hundreds of times. The cough is sometimes productive. He can usually tell which cough will turn into a syncope spell and either sit down or brace himself. It happens anytime of day or night (no consistency). Severe spells almost appears that he is having a seizure with eyes rolling back and arms flopping. He usually recovers within 5-20 seconds and is exhausted. He has had BP medication changed to make sure that wasn`t causing the cough. He has had endoscopy and has GERD, which he takes Aciphex (slightly improved the cough for a short time. definitley improved heartburn.) Went to an allergist and tested for allergies. Very mild to oak trees. Has had major sinus & nose surgery one year ago, correcting devitated septum & scraping out opacified sinuses (all). Helped a short time for post nasal drip. One year later, still feels like he has a cold every day. Blows his nose constantly and most days produces blood. Has been put on Predisone, Allegra, Singular, tried inhalers, etc. Recently diagnosed with severe obstructive sleep apnea for which he has been given a CPAP machine, which has definitely helped his snoring & allowed him to get some sleep, but still is fatigued. Has had lung CTs, chest x-rays. Very intelligent and educated man, however, needless to say all of this has caused much frustration, depression, weight gain. Any suggestions of where to go next? This is not the quality of life that he should settle for. Smoked from age 18 to 40. Hasn`t smoked for 15 years. Having an alcoholic drink makes it more difficult to recover from a syncope spell. I`m sure there is more, but I think you have the general idea. I would just appreciate any direction you could give us. thanks

Answer:

The cause of his cough syncope is most likely multifactorial.  It sounds as if he has chronic bronchitis due to his prior smoking history and has been treated with various inhalers and steroids.

Another important cause of cough syncope is pulmonary hypertension and it sounds as if your husband has several potential processes including chronic bronchitis and sleep apnea that may predispose him to pulmonary hypertension.  It may be beneficial to obtain an ECHO to measure his pulmonary artery pressures and right ventricular size and function.  If the ECHO suggests pulmonary hypertension, a cardiac catheterization is necessary to measure the pressures accurately.  There are several recently approved treatments for pulmonary hypertension that might be beneficial for him.  You should talk further with your primary care physician and heart and lung specialists.

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Response by:

Ralph   Panos, MD Ralph Panos, MD
Associate Professor
College of Medicine
University of Cincinnati