Saturday, August 14, 2010

Sjogren's Syndrome and Cough

Image found on Shorpy. 
Ah, geez. Here I go again.

If you heard me hacking a and coughing and wheezing today, I'm sure you'd think that I was at least a 2 pack a day smoker. Which I'm not.

Well, except for the time when I was six or so and Dad and Mom told us kids never to start smoking. And I, being the Bratty Outer Child Julia (vs. the Bratty Inner Child Julia that now resides here) that I was, told Dad that I could do whatever I wanted to. So there. And that included smoking. I seem to recall blowing a raspberry and sticking my tongue out at some point in that discussion.

So Dad, who smoked a pipe at the time, was silent for a moment as our eyes locked in a parent/child staredown. Finally he said, "So you think smoking would be a pretty good thing to do, eh?"

I can smoke if I want to, so there!

"Well, now. If you're going to smoke, there's no time like the present, I always say. Why don't you start right now?"

Now? Um. Well, OK! Nyeah! I will!

Dad calmly went to his desk and filled his pipe with tobacco. He lit it, and after taking a few puffs to make sure it was really smoking, handed it to me. My siblings gathered around, giggling. This had all the earmarks of some real entertainment.

I looked at it, then looked at Dad, then clamped the pipe stem between my teeth and began defiantly puffing in and out and in and out and in and out....

Funny how the room began to swim......hey Dad, when did you turn such a strange color.....gee, Mom, I don't feel so good........what's so funny, you guys?.........oh, man, think I'm going to hurl.........I barely made it to the back door and upchucked my entire lunch.

Dad! Are you crazy or something? I weakly asked. Why would anyone SMOKE?

And that was the last time my lips touched anything tobacco-ish.

So. I'm hacking and coughing over the last few days and it has nothing to do with any unsavory smoking habits. And this particular brand of coughing has unfortunately visited me pretty regularly. I don't like it. It starts out as a simple kind of dry tickle-in-the-throat thing with maybe a bit of sniffle. But then it progresses to the point where my chest feels tight and I cough almost constantly. It's exhausting.

The last couple times that this nasty cough has been problematic, I presented myself to my doctor, who ordered a chest x-ray and listened carefully to my lung sounds. The chest x-ray seemed normal. My doctor told me that a virus caused a minor irritation to my larger airway passages. This minor irritation changed to a major problem since Sjogren's had caused my airway passages to be dry and super sensitive. After doing some research, it seems as though many Sjoggies have hyper-reactive airways. Here's a quote but you can read the report in it's entirety from the medical journal Chest here.

Cough is observed in > 50% of patients with Sjögren syndrome and is the most common pulmonary symptom.66 The pathogenesis of cough is partly related to the drying of the mucosa in the upper airways, including the trachea (xerotrachea).67 One mechanism of cough in patients with Sjögren syndrome is the presence of bronchial hyperreactivity. A prospective study68 of 21 patients with Sjögren syndrome demonstrated slight-to-severe bronchial hyperreactivity to methacholine challenge in 60% of patients, and 83% in this group had a nonproductive cough. The bronchial hyperreactivity is theorized to be the result of lymphocytic inflammation leading to bronchial gland dysfunction.69 If other respiratory manifestations are present, there may be more than one pathogenic mechanism for the harsh cough observed in these patients. A majority of patients with cough and Sjögren syndrome have normal chest roentgenogram findings.6667 Treatment is symptomatic in patients with primary Sjögren syndrome and is disease-specific in those with secondary Sjögren syndrome. The role of long-term steroid therapy to treat cough in this group of patients is unclear.

She recommended some comfort measures such as humidifying my home with a cool mist humidifier, using over the counter cough medications, and sucking on menthol cough drops. 

It appears this nasty virus is back. Rats. Guess I'll have to keep an eye on things and head back over to the clinic if it hangs on. This may require a bit of additional investigation....


Laura said...

The cough also sounds, symptom-wise, like but not identical to an asthmatic cough. I wonder whether there could be any spasming involved as there is with asthma.

The root cause of asthma, the inflammation, is what the long-term steroid therapies treat. But the spasming that it can cause is what the short-term inhalers such as ventolin address. If your cough shares the spasming, regardless of its origin, maybe that would help. It seems worth asking, at least.

Of course, if that only settles the problem for a little bit and it resumes, then that may not be worth it, since like any medication ventolin can have side effects.

annie said...

When I start coughing more than usual, I increase my water consumption. I've also been prescribed 2 nasal sprays, one for inflammation and the other as a moisturizer for dry nasal passages. That has been helping me this year as I tend to block up completely and can't breathe.

A few years ago, when we thought my allergies had worsened and were the cause of most of my problems, I was put on ventolin. It worsened my coughing and hindered my breathing. It is fast acting, but it also irritates and dries passages. You have to find the right meds. My respirologist prescribed Oxeze? which I haven't used yet because thankfully I'm doing okay right now. Be well, Julia.

Julia said...

Thanks for the suggestions, guys. Come to think of it, about a year ago my dr. prescribed a simple albuterol inhaler, which helped. Might be something to talk to her about.

Laura said...

Albuterol is also ventolin (brand-name vs. generic :), and if it's helped you, then I will note that anecdotally I've found hot, caffeinated coffee (taken by itself) produces a milder but similar effect and could help if I had the signs of a mild attack on the horizon, though it wasn't very useful amid a full attack. A web search suggests this has been studied and hinted that it may be the case (hinted because, with just 10 subjects, that's not much of a study):

Julia said...

Oh, duh! I must really be off my game....of course albuterol/ventolin are the same.

I was thinking more along the lines of a single med inhaler vs. the combination inhalers.

Hm. Coffee. Interesting. I'll give that a try. Thanks.

Nina said...

I too have a cough that will not go away. The interesting part is when I mention I have Sjogrens syndrome to my doctors they basically say "that's too bad". I don't think a lot of doctors know much about sjogrens. I will be going back in today. My on going cough has lasted since Easter and keeps me up at night. Thanks- Nina

christy minard said...

i have had a cough that keeps me up at night for at least eight months straight and it came and went before that for a couple of years. i just got diagnosed with sjogren's in march. ive been using nyquil cough, other over the counter cough medicines, some nights two kinds together, halls super strong menthol cough drops, drinking tons of water, hot liquids, much caffeine, and now flovent (my son's asthma inhaler) twice a day preventively. i need to see a pulmonologist.... im waiting for appt. problem is getting worse. having asthma like attacks during the day where i get choked up to the point of tears streaming down my face and i end up almost dry heaving or gagging. it's very frightening. sometimes i think i should go to the emergency room. appt for pulm. doctor isn't until next january.

Robin said...

Wow! I thought I was going crazy. I have been "sick" on and off since September which includes this cough. I have a history of bronchitis...thanks to mom's genes :) but this cough is different. Like Christy, this cough is sometimes debilitating and my co-workers think I should be at home. The cough spasms are the worst! They can last for 5 to 15 minutes and I have difficulties breathing, I gag and everyone is afraid of it. I was prescribed Hydroxychoroquine because my hands were aching. I am supposed to take it twice a day. Unfortunately, I often forget to take it in the morning. I had no idea that my cough was related to sjogren's. I will definitely be more diligent about taking it twice a day. On top of all this, I have been dealing with chronic laryngitis. God has quite a sense of humour. I digress. I want to know what works for the coughing spasms. Help, please. BTW...thanks for all the advice already.

Mirah Riben said...

Thank you! Hoping you can FIX the LINK in this article to the Jr article.

All other online references simply say SS can cause a DRY COUGH. Mine started as dry tickle and now I am bringing up greenish phlegm which is how my SJ first started 6 years ago. Had a sinus infection.

I KNOW for sure that it is SSS connected because it gets better when I take my Evoxac and worsens as it wears off.

Anonymous said...

I was diiagnosed with Sjogren's 3 years ago after having the usual Symptoms of dry mouth and eyes etc and wIth medication these are managed. However, I do suffer from COPD and often get troublesome coughs. 2 nights ago I had a very distressing night which resulted in me coughing for so long approx 15 mins and approx 40 mins after very distressed. The upsetting thing is that I cannot remember anything about it. My doctor said that it was probably TGA (Transient Global Amnesia). This has happened 3 times now. Has anyone else suffered from these and what have you done to help alleviate them,