What could be causing my recurring coughs and chest congestion, given my history of similar symptoms, previous treatment with antibiotics and a steroid, and recent episodes of vomiting?

Recurrent Cough and Chest Congestion: Evaluation and Management

Most Likely Diagnosis

Your recurrent respiratory infections with cough and chest congestion most likely represent either post-viral cough syndrome, underlying asthma (possibly cough-variant asthma), gastroesophageal reflux disease (GERD), or upper airway cough syndrome—the three conditions that account for 92-100% of chronic/recurrent cough cases in otherwise healthy nonsmokers. 1

The pattern of improvement followed by recurrence, combined with chest congestion and vomiting episodes, suggests you need systematic evaluation rather than repeated courses of antibiotics and steroids.

Why This Keeps Happening

Post-Viral Cough Pattern

• Viral respiratory infections can trigger a persistent cough lasting 3-8 weeks even after the infection resolves, which may make you vulnerable to subsequent infections before fully recovering 2
• The vomiting you experienced is actually a classic feature of severe coughing episodes (post-tussive vomiting) and can occur with pertussis or severe post-viral cough 3
• Your chest X-rays being normal is reassuring and typical for most chronic cough cases 4, 1

Underlying Conditions to Consider

The three most common causes that need evaluation are: 1

1. Asthma (particularly cough-variant asthma): Can present with cough as the only symptom, no wheezing required 1

   • May be triggered by viral infections
   • Responds to inhaled corticosteroids 5

2. Upper Airway Cough Syndrome (UACS): Can be completely "silent" with no nasal symptoms 1

   • Due to rhinosinusitis, allergic rhinitis, or other sinus conditions
   • Most common single cause of chronic cough 1

3. Gastroesophageal Reflux Disease (GERD): Can cause cough without any heartburn 1

   • The vomiting episodes you mentioned could be related
   • "Silent GERD" is common with cough as sole manifestation 4

What You Need to Do Now

Immediate Steps Before Your Spring Break Appointment

Stop any repeat courses of antibiotics unless you develop fever, worsening symptoms, or your doctor specifically diagnoses bacterial infection. 2 The colored sputum you may have does not indicate bacterial infection—it simply reflects inflammatory cells from viral infection 2

Essential Evaluation Needed

When you see your doctor, you need: 4

1. Chest radiograph (already done—normal is good)
2. Spirometry testing (lung function test—mandatory for recurrent cough) 4
3. Bronchial provocation testing if spirometry is normal (to detect asthma) 4
4. Detailed assessment of:
   • Any nasal/sinus symptoms (even mild ones) 3
   • Heartburn, regurgitation, or symptoms worse after meals 3
   • Cough timing (worse at night, after exercise, with cold air) 3
   • Any wheezing or chest tightness 3

Treatment Algorithm Based on Your Situation

If Asthma is Diagnosed

Inhaled corticosteroids are the definitive treatment and provide long-term control 5

• Not just short courses of oral steroids
• May need 2-week trial of oral prednisone (30 mg daily) to confirm diagnosis if testing is unclear 4
• Long-term management with inhaled steroids prevents recurrence 5

If Upper Airway Cough Syndrome

Topical nasal corticosteroids are recommended 4

• Even without obvious nasal symptoms
• First-generation antihistamine plus decongestant can decrease cough severity 2

If GERD is Contributing

Intensive acid suppression with proton pump inhibitors (PPIs) for minimum 3 months is required 4

• Not just short courses
• May need twice-daily dosing 4
• Response can take weeks to months 4

Current Symptom Management

For your current cough: 2

• Honey, warm fluids, or simple cough syrups provide symptomatic relief
• Dextromethorphan 60 mg has proven efficacy for acute cough
• NSAIDs like naproxen may favorably affect cough
• Avoid repeated antibiotic courses without clear bacterial infection

Critical Red Flags to Watch For

Seek immediate re-evaluation if you develop: 3, 2

• Coughing up blood (hemoptysis)
• Fever with worsening symptoms
• Significant shortness of breath at rest
• Weight loss or night sweats
• Cough persisting beyond 8 weeks total duration

Common Pitfalls to Avoid

1. Don't accept repeated short courses of antibiotics and steroids without identifying the underlying cause 2—this treats symptoms temporarily but doesn't prevent recurrence

2. Don't assume normal chest X-ray means "nothing is wrong" 1—the three most common causes (asthma, UACS, GERD) all have normal chest X-rays

3. Don't ignore the possibility of multiple simultaneous causes 1—up to 25% of patients have more than one contributing condition

4. Don't wait for wheezing to consider asthma 1—cough-variant asthma presents with cough alone

You need systematic evaluation to identify and treat the underlying cause(s), not just repeated symptomatic treatment. Schedule comprehensive testing including spirometry and bronchial provocation testing at your spring break appointment, and be prepared to discuss a trial of empiric treatment based on your most likely diagnosis.