I am fit and healthy, but have been coughing for over a year. What is the cause? DR. MARTIN SCURR replies

I am a fit and healthy 72 year old woman, but have been coughing for over a year. It’s worse at night. Yet lung tests showed that nothing was wrong. What causes it?

Jo Bruce, via email.

Dr. Martin Scurr replies: What a frustrating problem, which undoubtedly affects the quality of your sleep.

A chronic cough – defined as a cough that lasts more than eight weeks – is common in people over 60, especially women. This may be because hormones such as estrogen (still produced after menopause) increase the sensitivity of the cells in the airways.

There are a number of possibilities for what the underlying cause could be, including asthma, chronic obstructive pulmonary disease COPD (mainly caused by smoking), and upper respiratory tract cough syndrome (due to excessive mucus from the nasal passages causing irritation in the throat and upper airways ). ).

Since your lung function tests were normal, it seems unlikely that asthma is the reason. COPD is unlikely because you don’t smoke.

Meanwhile, upper respiratory tract cough syndrome is almost always due to an allergy, for example to house dust. Mucus flows into the throat and you feel a constant need to remove it.

As with asthma, steroids may be the solution – not in the form of an inhaler, but as nasal drops (for example betamethasone) applied daily for four weeks.

Another possible cause is acid reflux, in which stomach acid leaks back into the esophagus due to a malfunction in the one-way valve where the two meet.

It causes heartburn and hoarseness, but is also one of the most common causes of chronic coughing, especially at night when you lie down and the acid can more easily leak back up. The fact that your cough is worse at night suggests that this is to blame.

The next step would be a trial of a proton pump inhibitor (e.g. omeprazole), which reduces stomach acid, to see if that solves the problem. Although you can buy this without a prescription, you will likely need a higher dose that is only available with a prescription. I recommend you consult your doctor about acid reflux as a possible trigger; chances are good that treating it can banish your troublesome cough for good.

I have a huge aneurysm (19 cm). My surgeon does not want to operate because of the risks. Is there anything else I can do? I’m 84.

Roger Baskeyfield, Wirral.

Dr. Martin Scurr replies: An abdominal aortic aneurysm is a common and potentially life-threatening condition that affects approximately one in seventy men over the age of 65.

The aorta is the largest blood vessel in the body and runs from the chest to the pelvis. But if there is weakness in the wall, it can develop a bulge (an aneurysm) that can lead to fatal bleeding if it bursts.

Risk factors for aneurysms include smoking, high blood pressure and elevated cholesterol. Yet one of the biggest factors is simply getting older and being male, for reasons that are not clear.

Men in Britain are offered screening when they turn 65: this involves a simple ten-minute check using ultrasound.

At 19 cm, your aneurysm is, as you say, huge (a 4 cm aneurysm is considered small; more than six is ​​very large). Nevertheless, you have reached the age of 84 without symptoms and there is a good chance that the disease has been spreading for years.

Surgery is the ideal treatment, but I suspect your doctors have decided that at your age the dangers of surgery outweigh the risks of a fracture.

There are other important steps that need to be taken; For example, many of the medications used to reduce the risk of cardiovascular disease can help.

It is vital to treat high blood pressure to prevent spikes that can strain weak blood vessel walls.

Statins are also often given because they can reduce inflammation in the blood vessel wall, while antiplatelet drugs – such as aspirin – can prevent the aneurysm from getting bigger. But one of the most important things a person can do is quit smoking.

Finally, some research recommends regular exercise as this may slow expansion, possibly by dampening inflammation.

I think…

Fear of this new breed of ‘surgeons’

Before Sir Anthony Eden became Prime Minister, he had to undergo ‘rescue surgery’ in the US to remove his gallbladder after years of pain and jaundice from gallstones

A quick but telling history lesson: before Sir Anthony Eden became Prime Minister in 1955, he underwent surgery to remove his gall bladder after years of pain and jaundice from gallstones.

It was a disaster and he had to go to the US for a ‘rescue’, but he still required several procedures over the next fifteen years.

This highlights the danger of complications from botched gallbladder surgery – yet we now hear that this potentially dangerous operation has been performed by surgical care providers (SCPs) on at least 170 patients at Walsall Healthcare NHS Trust since 2015.

SCPs are not physicians, but the surgical equivalent of physician assistants, about whom there has been a lot of concern lately.

The Royal College of Surgeons of England has rightly expressed concerns about the practice. Even though in some cases SCPs are supervised by a consultant surgeon or a doctor training to become a surgeon, this is still a major safety risk.

My big concern is that it won’t be long before we see cataract surgery and other potentially dangerous procedures being performed by personnel who are not medically qualified.