Dear Dr. Roach: I have a friend who has had an extremely bad cough, especially when she gets a cold. (It sounds like she is coughing up a lung.) She is a breast cancer survivor and has had this cough for a number of years. She has only had a chest X-ray done and was informed that she has asthma. She was given an inhaler.
I suggested that she request a CT scan of her chest to rule out anything else that could be going on, as this kind of cough is not normal and needs further investigation. What are your thoughts please?
R.L.Z.
There’s so much I don’t know that it’s harder than usual for me to comment. A cough that lasts for years could be due to several possibilities, but asthma is one of the most common causes. So, whoever considered asthma was wise. However, you can’t make a diagnosis of asthma with a chest X-ray (or by a CT scan either). The diagnosis is made by clinical criteria (a cough or wheeze are cardinal symptoms) and confirmed by pulmonary function testing. She may have had this done.
I suspect that you are also worried about a recurrence of breast cancer. Chest X-rays will pick up large lesions, but you are quite right that a CT scan is much more sensitive. A cough is a symptom that sometimes occurs if breast cancer comes back in the lungs. Unfortunately, breast cancer can recur, even after many years and decades.
If her symptoms get much better with the treatment of asthma, this would be considered strong evidence that it was actually caused by asthma. If not, then a further evaluation is called for, including a CT scan. But her doctors will also consider reflux disease and sinus problems with postnasal drip. There are many rare causes.
Medical treatments can sometimes lead to cough. Some chemotherapy drugs used in breast cancer can cause lung disease, as can radiation treatment.
Finally, I can’t tell you how many times I have seen a clinician forget to check if their patient is taking a blood pressure medicine in the angiotensin-converting enzyme class (whose names all end in -pril, such as lisinopril). These medicines frequently cause cough.
Dear Dr. Roach: Every so often, I break out in hives. I went to an allergist who told me to try Allegra in its generic form. I did, and it works great. My question is, what is the difference between Allegra and Allegra Hives, since they both have the same active and inactive ingredients?
P.L.
To the best of my knowledge, the answers are marketing and cost. In my opinion, you are best off staying with 180 mg of the generic fexofenadine, as it is working well and should be a much lower cost than the brand name.
When I checked one store online, 180 mg of generic fexofenadine is 13 cents a pill, while the brand name, Allegra, is 39 cents a pill. Allegra Hives is 67 cents a pill, but they are all the same medicine. Like most physicians, I personally use the generic versions whenever I can, with very few exceptions.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
