What Causes Persistent Cough, Fatigue And Wheezing In An Elderly Person?

Posted on Tue, 14 Jun 2016

Question: Good morning,
My 58 year old husband (who is very healthy other than having hypothyroidism) has been experiencing a dry, non-productive cough, inspiratory wheezing and need to clear throat for a couple of months now. Over the past couple of weeks he has been feeling "blah" and increased fatigue.
He's been checked by his primary physician and treated with a round of antibiotic for bronchitis (not diagnosed, just in case) and given an inhaler and tesslon pearls for his cough. He completed all meds and is still using the inhaler with no real improvement of changes (not getting worse either).
I can't convince him that he needs to get rechecked, but I'm worried.
Not certain what this could be, seasonal allergies are very high this year (Virginia) but he's never really suffered from those either.Alos did CXR which initially the MD though was pneuomia, but the radiologist read as clear,
Also MD evaluated for thyroid nodules and did not palate any nodules, etc.

Answered by Dr. Drkaushal85 (37 minutes later)

Brief Answer:
Get done PFT.

Detailed Answer:
Thanks for your question on Healthcare Magic.
I can understand your concern.
In my opinion, he should consult pulmonologist and get done
1. Clinical examination of respiratory system
2. PFT (pulmonary function test).
PFT is must for the diagnosis of bronchitis. It will also tell you about severity of the disease and treatment of bronchitis is based on severity only.
He may need long acting beta 2 agonist (LABA) (formoterol or salmeterol) and inhaled corticosteroids (ICS) (budesonide or fluticasone).
Don't worry, he will be alright.
Please let me know
1. Has he ever undergone PFT?
2. Does he smoke?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further. Wishing good health to your husband. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (43 minutes later)

Thank you so much for your quick response,
My husband has never smoked but DOES use chewing tobacco about 3 x/day for about 20 years.
He has never undergone a PFT.
He is not over weight, but has horrible snoring. He had a T&A done approximately22 years ago and initially that helped with sleep apnea, but gotten worse over the years.
Does not use any equipment for that.
Thank youAlso forgot to mention that the wheezing is primarily inspiratory. he does NOT get short of breath either.
Thank you
Also forgot to mention that the wheezing is primarily inspiratory. he does NOT get short of breath either.
Thank you

Answered by Dr. Drkaushal85 (1 hour later)

Brief Answer:
Has he ever undergone sleep study?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
In my opinion, he should definitely investigated again for sleep apnea.
So please let me know
1. Had he ever undergone sleep study?
2. Is he having excessive fat in neck region?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your husband. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (1 hour later)

He has never undergone a sleep study, and although he is very fit, he dos have a little excessive skin in the neck area. He always has, but a little more pronounced as we age.
If it wasn't for the noticeable, audible wheezing when we are sitting on the coach in the evening, it's not too noticeable. All his symptoms seem worse in the evening. In fact, he tells me he doesn't notice in the day, but I am at work, so not sure if he's being totally honest or really doesn't notice it.
His energy level has decreased and he is usually very active.

Answered by Dr. Drkaushal85 (7 hours later)

Brief Answer:
Has he ever undergone 2d echo?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Inspiratory wheezing, worsening as day progresses, fatigue, lethargy etc can be due to heart diseases.
And long term, untreated sleep apnea can cause heart damage and heart diseases.
So please let me know
1. Does he have edema feet as day progress?
2. Has he ever undergone 2d echo?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your husband. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (9 hours later)

No, he doesn't get any swelling at all. He has had cardiac markers done at his annual physical, but has never had a Echo. Not certain if heart disease runs in family, because he was adopted, but has not been diagnosed with any cardiac disease.

Answered by Dr. Drkaushal85 (5 minutes later)

Brief Answer:
Get done sleep study and 2d echo.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
He might be having worsening sleep apnea and this caused lung and heart disease and all the symptoms.
So better to consult sleep specialist and get done
1. Sleep study
2. 2d echo
He may need treatment for sleep apnea and cardiac diseases if present.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wishing good health to your husband. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar