I am a 72 year old woman, fit and healthy, but I have had a cough for over a year. It’s worse at night. However, lung tests found nothing wrong. What is causing it?
Jo Bruce, via email.
Dr Martin Scurr responds: What a frustrating problem, which undoubtedly affects the quality of your sleep.
Chronic cough, defined as cough lasting more than eight weeks, is common in people over 60 years of age, particularly women. This could be because hormones such as estrogen (which are still produced even after menopause) increase the sensitivity of airway cells.
Chronic cough, defined as cough lasting more than eight weeks, is common in people over 60 years of age, particularly women.
There are several possibilities for what the underlying cause could be, including asthma, chronic obstructive pulmonary disease, COPD (mainly caused by smoking), and upper respiratory cough syndrome (due to excess mucus from the nasal cavities that causes irritation to the throat and upper respiratory tract). ).
Since his lung function tests were normal, it seems unlikely that asthma is the reason. COPD is unlikely since he doesn’t smoke.
Upper respiratory cough syndrome, meanwhile, is almost always due to an allergy, for example, to house dust. Mucus flows into your throat and you feel a constant need to clear it.
As with asthma, steroids may be the solution, not in the form of an inhaler, but in the form of nasal drops (for example, betamethasone) that are applied daily for four weeks.
Another possible cause is acid reflux, where stomach acid backs up into the throat due to a failure of the one-way valve where the two meet.
It causes heartburn and hoarseness, but it is also one of the most common causes of chronic cough, especially at night when you go to bed and it is easier for the acid to rise again. The fact that the cough is worse at night suggests that this is the culprit.
The next step would be to try a proton pump inhibitor medication (e.g. omeprazole), which reduces stomach acid, to see if it goes away. While you can buy it without a prescription, you will likely need a higher dose with a prescription only. I recommend asking your primary care doctor about acid reflux as a possible trigger; There is a good chance that treating it can eliminate your annoying cough for good.
I have a huge aneurysm (19cm). My surgeon does not want to operate on me because of the risks. Is there anything else he can do? I’m 84.
Roger Baskeyfield, Wirral.
Dr Martin Scurr responds: An abdominal aortic aneurysm is a common and life-threatening condition that affects approximately one in 70 men over the age of 65.
The aorta is the largest blood vessel in the body and runs from the chest to the pelvis. But if there is weakness in the wall, a bulge (that is, an aneurysm) can develop, which could cause fatal bleeding if it bursts.
Risk factors for aneurysms include smoking, high blood pressure, and high cholesterol. However, one of the most important factors is simply getting older and male, for reasons that are unclear.
Men in the UK are offered screening when they turn 65; This involves a simple ten-minute ultrasound check.
At 19 cm, your aneurysm is, as you say, huge (a 4 cm aneurysm is considered small; more than six is very large). However, you have reached 84 years of age without symptoms and it has probably been getting worse for years.
Surgery is the ideal treatment, but I suspect your doctors have decided that, at your age, the dangers of an operation outweigh the risks of a rupture.
There are other key measures that must be taken; For example, many of the medications used to reduce the risk of heart disease can help.
It is vital to treat high blood pressure to prevent spikes that can put pressure on weak blood vessel walls.
Statins are also often given, as they can reduce inflammation in the blood vessel wall, while antiplatelet medications, such as aspirin, can prevent the aneurysm from growing. But one of the most important things anyone can do is quit smoking.
Finally, some research recommends regular exercise, as this can slow expansion, possibly by decreasing inflammation.
In my opinion…
Fears about this new generation of ‘surgeons’
Before Sir Anthony Eden became Prime Minister, he had to undergo “rescue” surgery in the US to remove his gallbladder after years of pain and jaundice from gallstones.
A quick but revealing history lesson: before Sir Anthony Eden became Prime Minister in 1955, he underwent surgery to remove his gallbladder after years of pain and jaundice from gallstones.
It was a disaster and he had to go to the US for “rescue” surgery, but he still needed several procedures over the next 15 years.
This underscores the danger of complications from failed gallbladder surgery; However, we now know that this potentially dangerous operation has been performed by surgical care professionals (SCPs) on at least 170 patients at Walsall Healthcare NHS Trust since 2015.
SCPs are not doctors, but the surgical equivalent of associate physicians, about whom there has been a lot of concern recently.
The Royal College of Surgeons of England has expressed alarm at this practice, and rightly so; Although, in some cases, SCPs are supervised by a consultant surgeon or a doctor with training to become a surgeon, this remains a significant safety risk.
My big concern is that it won’t be long before we see cataract surgeries and other potentially dangerous procedures performed by personnel who are not medically qualified.