Benzonotate for coughing

Coughing (mostly at night) and during social events really irks me, especially in light of the twice a day airway clearance I do. Things could be worse but right now it tops the list for most annoyance and bother. So, in other words, @brian93 I can relate!

I can tell you what I do but it's not perfect and foolproof. First, try 2 vials of 7% saline prior to airway clearance. Work to clear as much gunk and no more than 45 minutes. I usually try to get the 2nd airway clearance session in before dinner. If I feel gunky before bed I use autogenic drainage to clear what I can (10 minutes-ish). I also keep an albuterol inhaler on my bedside and if I wake up coughing I take a puff. It calms the coughing without making me jittery.

Sleeping propped up on a wedge can help. Avoid eating/drinking 3 hours before sleep. Treat GERD if that's an issue for you.

Have you been worked up for asthma? Sometimes asthma can add to the coughing burden. If so, an inhaled corticosteroid can help reduce inflammation, and therefore coughing. Also, it's worthwhile dropping off a sputum sample to see if you have a current infection as an antibiotic might be prescribed. An infection can cause additional coughing.

Outside of an active infection, some people take azithromycin 3x week to control inflammation, which helps reduce cough. Your doctor will need to make sure you do not have NTM first, as azithromycin is a mainstay treatment in NTM. Some doctors shy away from prescribing it to non-NTM patients for that reason. On the other hand, several people here have been on it for years with good results. My pulmonologist said there's some evidence (scant) that azithromycin can help prevent NTM. More research is needed.

You mentioned benzonotate. I've tried the smallest dose and it helps some. I do not like to take often as I think it interferes with airway clearance. What really helped when I was sick and desperately needed sleep was a codeine based cough syrup. OTC Delsym or Robitussin can also be useful at night when you're sick with a cold.

Thank you. Your routine is similar to mine. Yes with all the work we do with our twice daily airway clearance, it's still never keeps the cough away. Very frustrating.

https://en.wikipedia.org/wiki/Benzonatate

Scoop- How long have you known you had BE?
Did the coughing and needing to clear out the mucus go from one extreme to another? Meaning that originally there was very little but some need during the day to clear mucus out of the lungs to nearly having to clear it out all the time. Did it start out as needing to be cleared out all the time?
It started out for me with just needing to clear it out in the mornings for a very short period and then changed to nearly constantly all day long....and as well at night.
I am doing better at night with the mouth taping, less sticky/thick sputum/mucus and easier to remove if I need to when I wake at night to do what my bladder tells me I need to do.
Barbara

I have asked my pulmonologist if I can use 7% saline more than twice a day or more than one at once and he said absolutely not. Please check with your dr on this just in case. I wish I could. I have dry BE and could use the extra help!

I am curious, did he say why you couldn't use is more?
Sometimes I fail, sorry to say, to ask why they said what they said...."such as: "What type of harm or what are we trying to avoid by not doing it more than one time a day.?"
Wish we were always On Our Toes so to speak with the professionals to have the right question ready to inquire with them each time they say something and don't give an explanation.....it's like a parent telling a child not to do something without being kind enough to explain why they shouldn't do what they are doing." My take on it.
Barbara

My pulmonologist considers it to be a serious irritant, and suggests only using as much asmis needed.
Sometimes I wonder if the constant irritation might be the cause of excessive mucus production by some of us.

As I recall, human testing of 7% saline was 3 to 4 ml once or twice a day - sorry I don't have the study bookmarked anymore. I can tell you from personal experience that the saline I inhale one day is still detectable in my mucus the next - I can taste it.

Sometimes more isn't necessarily better. Maybe if you need an extra boost of fluid in your lungs you can use normal (.9% ) saline - same salinity as your bodily fluids.

Here is a look at several studies, the results are all over the place, but consistently called for treatment once or twice a day. That is also the recommended dose by NJH.

In addition to improving viscosity of mucus, the salinity inhibits the ability of NTM to multiply.

Dr. McShane suggests two 4ml vials to “wet down” the lungs in her most recent AC video. Though she also suggests once a day AC is fine, plus daily cardio exercise. I started doing two 4 ml vials maybe a month or so ago and I find it helps me to be more productive (as someone who is otherwise not productive). I do this once a day. I generally feel well and tolerate the saline fine. I can imagine others whose lungs are more sensitive may not benefit from doubling up, but for me, so far, it seems to be an improvement. Also, if one has a lot of mucus doubling up may not be necessary, and am/pm saline sessions may be more beneficial to help with breathing and cough. But it is a question on my list for my upcoming NJH visit.

My pulmonologist is wondering if the 7% saline is what’s causing my reactive airway. For about 2 years now I can’t tolerate perfumes, alcohol gel, cleaning agents, hair products on coworkers, vinegar smells, frying foods,…. The list seems to be growing every week and my coughing spasms are getting worse. My doctor is testing an inhaled steroid and if that doesn’t work (which it hasn’t) I’m afraid he’s going to want me to stop the 7%. Nebulizing 1x day really helps get mucus plugs up. I’m afraid my MAC will come back. Has anyone gotten a reactive airway from the 7% nebs?
Sorry if this is off the original topic, I couldn’t see where to post a new question.

Can you try a lower concentration like 3%? As I read this I realized my choking episodes, which used to be daily, are rare now that I am using saline only occasionally.