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Lingering cough with post nasal drip

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I've had a lingering cough for about 4 weeks now. No fever, don't feel as if I'm sick either. It is usually either due to feeling a tickle in the back of my throat or trying to clear the mucus. The mucus is mostly clear. In the morning, it is sometimes yellowish, but once I cough that up, it's clear for rest of the day. For the last week my nose has been a bit stuffed. It's not completely stuffed, but definitely not all clear either.

I've never really had allergies, although my doctor about 15 years ago said I have postnasal drip. Last year, I bought a house, so this spring/summer I've been doing a bit of yard work, if that matters. Although, I haven't done any in 2 weeks, but the cough hasn't cleared up.

I'm 34, never smoked, don't drink, and am fit (exercised a few times a week until recently when I hurt my knee).

Since it's been about 4 weeks, I'm starting to get a bit worried. Lots of time the cough is self induced to clear up the mucus. I thought about having a sinus infection, but I have no other symptoms. No headache, no fever.

Category: Family Physician-GP

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Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.


Thank you for asking your query at DoctorSpring.

The presence of - throat irritation, mucus, stuffy nose (a week ago), and sputum production point towards two possible diagnosis in your case.

1. Allergic cough / Allergy related cough
2. Allergy related cough with a Secondary infection

The approach to the symptoms would be to treat the allergic component and see whether there is resolution of the symptoms. For that I recommend the following steps.

1. An OTC anti allergic medication (like Cetirizine) twice a day for 5 days.
2. Steam inhalation through mouth and nose (alternate) twice a day for 5 days
3. Saline gargle using mild warm water if there is throat irritation.

These steps should address the allergy component of the cough and if there is no infection the symptoms should resolve. Sometime a bacterial or viral infection can occur over an allergic cough (as a secondary infection). In that case the above approach might not be enough and you may require a course of antibiotics. A chest Xray might also be needed in that case. So if there is no resolution of symptoms for 4-5 days you should consider visiting your Doctor.

There are no alarming symptoms here, and so there is no need to worry about the ‘4 week’ duration. This is probably allergic or allergic + infective cough. Even if there is infection, it should be a common upper respiratory bacteria or virus which can be easily treated. Sinus infection is not likely in this scenario.

Hope this helps.
Please feel free to ask follow-up questions.

Patient replied :

Thanks for the reply! Two quick follow up questions...

1. I forgot to mention, but I've been taking Allegra for the last 3 days. I haven't done the other things you mentioned though, which I'll start today. I think Allegra has helped a bit, but hard to tell, because I'm not sure how I'd feel if I wasn't taking it. Should I be taking Allegra-D instead, I'm only taking the standard one.

2. When you mention if it doesn't go away in 5 days to see my doctor and a chest Xray might be needed. Is this to rule out pneumonia? Just wondering, since I had pneumonia 13 years ago and I felt horrible, with fever, body aches, etc..., none of which I currently have.

Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.


1. In that case continue Allegra for 2 more days with the other measures and see the response. Plain Allegra is good enough.

2. Yes you are right, the chest Xray is to rule Pneumonia. This is required only if you have ‘chest symptoms’ on clinical examination. However the probability for pneumonia is very less as you have predominant allergy related Upper respiratory tract symptoms.

Hope this helps.
Thank you.

Dr. Deepu Sebin Sebastian
Category: Select Speciality
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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