Chronic Cough Due to Statins

Statin drugs (simvastatin for example) are commonly used to treat high cholesterol and have many known side effects... but here's another. Statins are now believed to potentially cause a chronic dry cough according to a recent report!

This chronic cough side effect is common in other types of medications such as ACE-Inhibitors (lisinopril) and angiotensin receptor blockers (losartan) to treat high blood pressure.

Statins were not previously known to cause a chronic dry cough.

Reference:
Chronic cough as a complication of treatment with statins: a case report. Ther Adv Respir Dis. 2012 Jul 3. [Epub ahead of print]

Fauquier Hospital Now Offers 24 Hour Multichannel pH and Impedance Testing for Reflux!

As far as we know, Virginia Hospital Center's Heartburn Center in Arlington, VA and now Fauquier Hospital are the only places in Northern Virginia that offers 24 hour Multichannel Intraluminal Impedance (MII) testing to look for non-acidic reflux. Oftentimes, this test is combined with pH probe testing and manometry to measure the more traditional acid reflux as well as esophageal motility.  These tests are important when working up patients with symptoms of chronic cough, globus, phlegmy throat, and/or throat clearing when all other reflux measurements/testing have come back normal.

The testing is performed by placing a catheter through the nose and into the stomach AND leaving it in place for 24 hours. Patients often ask what this looks like... so here's a few pictures!

Here are the contact information for the locations that provide 24 hour Multichannel pH and Impedance testing:

Gastroenterology Associates
(in association with Fauquier Hospital)
402 Hospital Drive
Warrenton, VA 20186
Phone: (540) 347-2470
Website

Virginia Hospital Center
Phone: (703) 717-4373
Fax: (703) 717-4374
Director: Kevin Gillian, MD, FACS
Nurse Coordinator: Susan McNeill-Smith, RN
Website

Some over-the-counter medications used to treat relux are listed below:

Mattress Wedges for Reflux Treatment

I often see patients with throat symptoms of reflux including:

• Cough
• Throat-Clearing
• Phlegmy or Mucus Sensation in the Throat
• Mild Sore Throat
• Swollen sensation in the throat
etc, etc, etc

Although this can be treated with medications including proton pump inhibitors (prilosec, prevacid) as well as H2-blockers (zantac, pepcid, axid, etc), there are some lifestyle changes which also can be just as if not more effective than medications. Such lifestyle changes include:

• Nothing to eat/drink within 3 hours of lying down to sleep (the stomach would be empty minimizing chance of reflux)
• No fatty, spicy, acidic, tomato-based products in the diet
• No caffiene
• No alcohol
• Keep the head elevated more than 30 degrees when sleeping

This last bit of advice where the head should be higher than your feet is best accomplished by tilting the entire body rather than just the head by using more pillows.

Why?

You want not just the head tilted higher, but your chest too as you do not want the reflux entering the chest region either.

There are three ways of accomplishing this.

• Sleep in a chair
• Tilt the ENTIRE bed by placing 2-3 bricks under the legs of bed
• Get a mattress wedge!

What is a mattress wedge?

It is pretty much what it sounds like... It's a wedge you can place under the mattress so the mattress is tilted rather than the entire bed.

All sorts of wedge sizes and placement can be purchased. Here's a few I found on Amazon.com: