I’m a fit and healthy 72-year-old woman but have had a cough for over a year. It’s worse at night. Yet lung tests found nothing wrong. What’s causing it?
Jo Bruce, via email.
Dr Martin Scurr replies: What a frustrating problem, no doubt affecting the quality of your sleep.
A chronic cough — defined as one that lasts for more than eight weeks — is common in those over 60, particularly in women. This might be because hormones such as oestrogen (still produced even after the menopause) increase the sensitivity of cells in the airways.
A chronic cough — defined as one that lasts for more than eight weeks — is common in those over 60, particularly in women
There are a number of possibilities for what the underlying cause might be, including asthma, chronic obstructive pulmonary disease COPD (primarily caused by smoking) and upper airways cough syndrome (due to excess mucus from the nasal cavities causing irritation in the throat and upper airways).
As your lung function tests were normal, it seems unlikely that asthma is the reason. COPD is unlikely as you don’t smoke.
Upper airways cough syndrome, meanwhile, is almost always due to an allergy, for example, to house dust. Mucus flows into the 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 as nose drops (for example, betamethasone) applied daily for four weeks.
Another possible cause is acid reflux, where stomach acid leaks back up into the gullet due to a fault with the one-way valve where the two meet.
It causes heartburn and hoarseness but is also one of the most common causes of chronic cough — especially at night when you lie down and it’s easier for the acid to leak back up. The fact that your cough is worse at night suggests this is to blame.
The next step would be a trial of a proton pump inhibitor drug (e.g. omeprazole), which reduces stomach acid, to see if that clears it up. While you can buy this over the counter, you will likely need a higher dose that’s prescription only. I’d recommend consulting your GP about acid reflux as a possible trigger — there’s every chance treating it could banish your troublesome cough for good.
I have an enormous aneurysm (19cm). My surgeon won’t operate because of the risks — is there anything else I can do? I’m 84.
Roger Baskeyfield, Wirral.
Dr Martin Scurr replies: An abdominal aortic aneurysm is a common and potentially life-threatening condition that affects roughly one in 70 men over the age of 65.
The aorta is the largest blood vessel in the body, running from the chest to the pelvis. But if there is weakness in the wall, it can develop a bulge — i.e. an aneurysm — that could result in fatal bleeding if it bursts.
Risk factors for aneurysms include smoking, high blood pressure and raised cholesterol. Yet one of the biggest factors is simply ageing and being male, for reasons that aren’t clear.
Men in the UK are offered screening when they turn 65 — this involves a simple ten-minute check using ultrasound.
At 19cm, your aneurysm is, as you say, enormous (an aneurysm of 4cm is considered small; over six is very large). Nevertheless, you have reached the age of 84 without symptoms and it’s likely it’s been expanding for years.
Surgery is the ideal treatment but I suspect that your doctors have decided that, at your age, the dangers of an operation outweigh the risks of a rupture.
There are other key steps to take — for example, many of the drugs used to reduce heart disease risk can be of help.
It’s vital to treat high blood pressure to avoid spikes that might put strain on the weak blood vessel walls.
Statins are also often given as they can reduce the inflammation in the blood vessel wall, while antiplatelet drugs — such as aspirin — may stop the aneurysm getting bigger. But one of the most important things anyone can do is quit smoking.
Finally, some research recommends regular exercise as this may slow expansion, possibly by dampening inflammation.
In my view…
Fears about this new breed 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 telling history lesson: before Sir Anthony Eden became prime minister in 1955, he had 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 underlines the danger of complications from botched gallbladder surgery — yet we now learn this potentially hazardous operation has been carried out by surgical care practitioner (SCPs) on at least 170 patients at Walsall Healthcare NHS Trust since 2015.
SCPs are not doctors but the surgical equivalent of physician associates, about whom there has been much recent concern.
The Royal College of Surgeons of England has expressed its alarm at the practice and rightly so — even though, in some cases, SCPs are supervised by a consultant surgeon, or a doctor training to become a surgeon, this is still a major safety risk.
My great concern is it won’t be long before we see cataract surgery and other potentially hazardous procedures being carried out by staff who are not medically qualified.
Source: Mail Online
