Have her take respiratory tests

Dear Dr. Gott: My 84-year-old wife has a chronic cough that nothing seems to help. One doctor indicated she has scars on her lungs. If this is true, what’s the answer for a cure?

Dear Reader: Chronic cough may not always indicate a primary lung disorder, such as pneumonia or bronchitis. Postnasal drip (sinus drainage from allergies), chronic sinus infection, heart failure and hiatal hernia are associated with a troublesome, dry cough.

Also, certain drugs (notably the ACE inhibitors used for heart disease and hypertension) will cause a chronic, racking cough in about 10 percent of users.

I do not believe that your wife’s pulmonary scars are the cause of her cough. Rather, the scars indicate a previous infection or injury. Nonetheless, until the cause of her lung scarring is determined, I’d be concerned that she might be suffering from a long-standing, low-grade pulmonary infection, such as bronchiectasis, abscesses within the lung tissue.

In my opinion, your wife needs to address the issues I raised. For instance, sinus X-rays and special lung X-rays (CT bronchography) would establish the presence of infection in those two areas; a cardiac ultrasound could demonstrate a weakened heart muscle; an upper intestinal X-ray study might document a hiatal hernia.

Before throwing up her hands in frustration, your wife should undergo the necessary testing, which would enable the doctor to prescribe the necessary treatment, such as antibiotics, antihistamines or antacids.

Dear Dr. Gott: Please discuss aspiration pneumonia.

Dear Reader: The inhalation of foreign material causes lung inflammation. Such foreign material includes objects such as peanuts, various vapors and fumes (especially hydrocarbons), and gastric acid. It’s this last factor that presents such a challenge, because stomach acid, when it enters the lung, digests pulmonary tissue, as well as causing pneumonia.

Aspiration of gastric contents commonly occurs when an unconscious patient vomits. Therefore, aspiration pneumonia is a frequent complication of serious injuries, coma, heart attack, stroke – and surgery. (This is the reason why anesthesiologists customarily place airway tubes in the throats of patients undergoing surgery.)

Aspiration pneumonia is diagnosed by X-ray tests and is treated with a combination of antibiotics and steroid drugs. As with many avoidable medical conditions, doctors and other health care workers prefer to prevent this complication rather than to treat it once it develops. Thus, laymen are encouraged to turn unconscious patients on their stomachs, rather than keeping them on their backs.