Old 01-05-2018, 03:14 PM #1 (permalink)
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Default coughing constantly

started yesterday afternoon And causes hours long choking episodes
no fever but my family has had bad colds
feels like annoying nasal drip but can't cough it up even with cough assist and suction
bipap air blowing down my throat is causing more violent episodes

don't think it's sickness other than als
more and more thick saliva that must be suctioned

hospice nurse coming out tomorrow for first time, but don't expect they will know about als

wondering if I need that vest to help lungs break up or nebulizer. What do you experts think. I don't have either or know much about them
!
this is miserable, the worst I've experienced in four years t
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Old 01-05-2018, 06:42 PM #2 (permalink)
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Default Re: coughing constantly

Possibly the bipap did this to you. Perhaps something in the air got into your air supply. Maybe some mold grew in your equipment or the hoses.

I'm no expert, but I would take three meds. First, a Benedryl in case this is an allergic reaction to something you breathed in. Second, a pseudofed to dry up that post-nasal drip before the snot really irritates your throat. Third, a cough suppressant so your body won't feel the need to cough.

I'll emphasize: I'm no expert. All three of those meds might contain things that suppress your breathing dangerously.
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Old 01-05-2018, 06:51 PM #3 (permalink)
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Default Re: coughing constantly

I wouldn't load up on drugs just yet -- some of those are sedating and others the opposite. Sudafed is just bad stuff generally, as is Benadryl, mostly. You might try a cough med with DXM in it.

If the BiPAP water chamber, mask and hoses are as clean as ever, the mold theory is unlikely but not hard to check -- each can be sniffed.

Has your use of central heating or other dust-generating apparatus changed in any way? Is anyone using like a new humidifier, vaporizer, aerosol or anything?

You could be working on the family cold -- they can manifest differently for you, esp. if the nasal drip feeling is in your throat rather than chest. Does the thick saliva have mucus in it?

You can reduce the BiPAP IPAP and play with the humidification (could work better up or down) for starters.

Do you have or take anything for allergies, mucus normally? Do you take other drugs?
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Old 01-05-2018, 07:24 PM #4 (permalink)
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Default Re: coughing constantly

I take lexapro, , A probiotic, just started nuedexta yesterday after the coughing started, Flonase and mj.

Avap machine kept clean.
Thick saliva is clear
Coughing all day but not as violent
Hoping ight goes well

Thanks for help
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Old 01-05-2018, 07:58 PM #5 (permalink)
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Default Re: coughing constantly

Hi Azgirl...I flush my sinuses twice a day with saline as they get dry from the avap and backed up with mucus which gets in my lungs. Keeping my sinus cavities moist and clear helps a lot.

My husband thumps my back once a day to loosen the phlegm in my lungs.

When my lungfs feel very tight i do a breathing treatment with a nebulizer and albuterol. I have asthma as well and the albuterol opens the airways.

I have trouble coughing as well but I find that if I can a bubble of air behind the mucus I can get it up to suction. Often it ends up in my stomach.

I also have humidifiers running as the dry air makes me cough. I go out in the rain periodically to get lungfulls of moist cool air.

Wishing you the best
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Old 01-06-2018, 01:38 AM #6 (permalink)
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Default Re: coughing constantly

Yes, clean humidification whether on or off BiPAP is recommended. Always do overkill on furnace filters, bathroom fan filters, etc.

azgirl, have you tried papaya or pineapple juice, soda? Tube or mouth does not matter.

As to your question on trying the vest or a neb, probably the vest would be more on point.

Nuedexta has the potential for serious interactions with the Lexapro and probably isn't going to affect the cough...I wouldn't risk it myself...let us know how the night goes.
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Old 01-06-2018, 08:12 AM #7 (permalink)
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Default Re: coughing constantly

Thanks for the ideas/reminders every one. Better night with only 3 bad episodes-but now my ribs are killing me from all the hacking.

It's so dry here that it's hard to get enough moisture in the house, will try running humidifier all day and night . Our heat pump was broken last week (thankfully we don't live out east right now) perhaps the work they did stirred up the dust.

Also will try putting a coke down the tube, have been using alka selter.

Laurie, I was also concerned about the interaction of lexapro with nuedexta which is why I hadn't tried it before. Will see my neurologist this week, probably for the lt time if I opt for hospi today, so will ask her about it . And also bipap settings

Can't imagine fighting this monster with out the forum support
Thanks agin
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Old 01-10-2018, 08:25 PM #8 (permalink)
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Default Re: coughing constantly

azgirl, some great info in this thread.

A few times I had coughing fits that lasted for days. It was difficult to get air, ribs, abdomen hurt. The hospice nurses thought I might not survive, I too thought a few times I was out of air and finished.

It was phlegm each time clogging my throat and / or phlegm in my lungs my body was trying to expel.

lowering my bipap pressure much lower during coughing fits helps me a lot, the air blowing making the phlegm shake caused more coughing.

Also, reclining back more also reduces the coughing. Laying on my side helps the phlegm come up also

Inventor2 has lots of tricks, I will ask him to chime in.

I don't try to stop my saliva. The saliva helps move the phlegm. I drink at least 2 liters of water daily, so I don't get dry.

Good luck Beautiful - Pat

a related thread:

https://www.als.net/forum/yaf_postsm...va.aspx#421644
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Old 01-12-2018, 04:45 AM #9 (permalink)
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Default Re: coughing constantly

Hope you're ok

most of my phlegm comes from the back of my nose, like post nasal drip, but it comes down in sheets, that choke and gag me

the best help I have found is PharmaNac, is thins out the phlegm

when the phlegm is in my lungs, thats when the coughing fits start. If I do cough assist before the coughing starts, that sometimes helps.

if a coughing fit last a couple of days, a tiny amount of morphine can help the muscles calm

TGIF - Pat
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Old 01-12-2018, 05:31 AM #10 (permalink)
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Default Re: coughing constantly

My main trick against coughing episodes before tracheostomy was spending an hour or two in the Trendellenburg position, i.e. lying flat with the feet end of the bed raised 2-3 feet with the Hoyer lift. That brought the stuff causing irritation into the throat where it could be suctioned out.
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Old 01-12-2018, 05:34 AM #11 (permalink)
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Default Re: coughing constantly

For post nasal drip, NAC and tea with a teaspoon of crushed ginger.
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Old 01-12-2018, 01:09 PM #12 (permalink)
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Default Re: coughing constantly

Mucinex works wonders for me when I have excess mucous and phlegm. IMO Nudexta will be insignificant and won't solve your issues.

Our late mentor....MAX, took mucinex twice daily because he had excessive mucous etc.
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Old 01-12-2018, 01:22 PM #13 (permalink)
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Default Re: coughing constantly

Medication allerg? Lisinoprill gave me a little dry cough--ALL the time until I quit that med.
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Old 01-12-2018, 01:31 PM #14 (permalink)
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Default Re: coughing constantly

AZgirl already listed her meds. She does not take an ACE inhibitor.

Agree with everyone's tips (note those with liver and/or kidney issues should seek medical advice before trying NAC) and esp. hydration rather than trying to "dry up the drip," as the "Sudafed"-type drugs do. In the long run, that creates more irritation and makes it harder to clear out the secretions, so they continue to cause irritation.

Additionally, in dry winter weather, even before you get to weakening muscles, BiPAP flow (IPAP) often requires adjustment as too great a flow is irritating in and of itself, as others have pointed out, and especially during active coughing spells, flow should be reduced to comfort. Many PALS have minimum IPAP set too high anyway. Since the airflow reduction in ALS is more restrictive than obstructive, it generally does not require the huge IPAPs that say, an obese smoker with COPD may require.
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Old 01-13-2018, 02:38 PM #15 (permalink)
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Default Re: coughing constantly

Laurie, thanks for the warning about NAC n stones. I will cut back, I am prone to kidney stones ( was told all paralyzed folks r ). I have been doing losts of NAC for a few years without trouble, yet I will try cutting back.

I did Inosine for a year to midly increase uratic acid levels n that gave me kidneys stones.

What r the concerns with Sudafed? U mentioned its bad stuff generally, just curious.

My hospice recommends Levsin for both phlegm n saliva. I will give it a try again, it works well for saliva, but my issue is phlegm.

Papaya Enzymes help, but I don't want anything in my mouth anymore.

A dietitian just visited us, we talked about papaya n pineapple juice, but she said don't put them in the tube. I think shes wrong, we're smart, we'll strain the juice, we won't clog it. Maybe she was concerned about acid damaging the tube? Any thoughts Y'all?
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