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    Parkinson's disease and chronic cough
    KarenCEagan posted:
    HI - My Dad has Parkinson's disease and dementia associated with it. He has developed a chronic cough for several months now and it is getting worse. It is especially worse at night which interupts his slleep for both he and my mom. This making them exhausted and whevere he has a bad night, he is certain to have a bad day.

    Is this cough related to the Parkinson's and how can we best treat it? We've seemed to have tried everything - antihistamines, antibiotics, nasal spray, acid reflux meds, cough meds, etc. Nothing has worked.
    We need help. The situation is very difficult. Any information will be greatly appreciated.
    Thanks, Karen
    Mark A Stacy, MD responded:
    Hello, Karen
    I am a bit stumped by this one. It would be helpful to know if he has a productive cough (sputum or saliva?) or not. In addition whether he has increased salivation or drooling. If that is the case, he may have pooling of his saliva, which will initiate a cough reflex.

    If there is no productive cough or increased salivation, I would recommend an evaluation by a speech therapist, specifically for any factors that may enhance a cough reflex.
    BKBarnes replied to Mark A Stacy, MD's response:
    My husband is 73 and this last year has developed same coughing as Karen described. yes, he sometimes has a productive cough sometimes but not ALL the time - he has increased salivation and drooling. His cough is "Violent"......he pretty much has to sleep in his recliner.....we were told it was reflux but we have tried everything and I truly do not believe that is it. His doctor today just prescribed steroids as next effort to help. bb
    BKBarnes replied to BKBarnes's response:
    This was my first time to use this means of communication and I realize I did not explain everything. Yes, he has had PD for appx 15's getting much worse......he has done the swallowing test and all that proved was he was NOT to drink out of a straw (which he does not do often anyway). I read on another one of your replies that sleeping on his side my help - we''ll try that. Is there anything else he can do for this horrible cough. to me, he sounds like his is filled with congestion BUT the doctor says his lungs are clear.....which makes me wonder if that "congestion" sound could be caused by the pooling of his saliva....on the other reply I found of yours, it mentions using: small amount of amitryptiline, trihxiphenidyl or diphenhydramine...what are those states it may cause confusion - is that after a period of time or just trying it.....injection with botulinum toxin (please explain that as well)to each parotid gland. We desperately need help!

    Mark A Stacy, MD responded:
    Dear Karen,
    The cough may be from aspiration, or breathing saliva into his lungs while he is sleeping. This, usually slightly acidic solution can cause irritation of the bronchial (breathing) tubes, and the natural reflex is a cough.

    I would suggest a swallowing study to see if he is aspirating, and perhaps a sleep study to see if there are other issues. His neurologist can order both of these studies.
    sandbk responded:
    My dad (81 yrs) has a very similar problem. He has had Parkinson's for about 23 years and also has dementia associated with it. Since March he has been waking up an hour or so after he goes to sleep breathing with great difficulty, coughing, (sometimes violently) and it sounds like he is gurgling every time he breathes. It makes him shake even more than usual and he has a very hard time returning to sleep. He lives with me and my husband and none of us are getting any sleep. His neurologist hypothesized he was losing his ability to protect his airway when he was falling asleep, but he sleeps fine during the day... He also prescribed Amytriptiline to help dry up his saliva at night but it has not helped at all. Often if I can get his shaking settled down with a little extra sinemet, or make sure he's not in pain (Tylenol) he gets back to sleep and sleeps through the night.
    He has also been complaining of headaches almost every day and night... I suspect he is having sinus problems and maybe the drainage in the back of his throat at night is causing this? He just saw an ENT who has ordered a CT scan of his sinuses. It is really nerve wracking and it happens EVERY night.
    erik1000 responded:
    I never thought I would find others with basically identical circumstances.

    My father is 82 y/o and lives with me (I am his son). He has PD and dementia.

    Over the past 2 months he has began to cough during the night, so much so that I cannot sleep.

    It is a strange elongated cough, followed by a yawn. It happens mostly during the night, but oddly when he sleeps during the day, it does not happen.

    I should note that he drools extensively, and has problems swallowing, but this has never affected his sleep time before.

    Anyway, I have tried everything to stop the cough. I have bought a hospital bed, specifically to raise him from his waste as he sleeps, I have used Nasonex for post-nasal drip, I have changed bedrooms (in case of allergy), I have used different air-conditioning settings, and I have tried a host of cough medications.

    I have found only 2 things that have worked however. The gas heater reduces the coughing down to about 20% of the usual.

    However Nurofen Plus (Codeine Ibuprofen) shuts his coughing down completely, at least for the night.

    The downside is that it gives him constipation the next day.

    I hope this is helpful to all the other carers who will no doubt find this topic one day after they too get bamboozled by this very distressing complication.

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