Pulmonary specialists find non-surgical cure for woman's incessant cough

Not long ago, on the separate advice of physicians from three well-respected U.S. medical centers, Gwenneth Smith faced the unhappy prospect of having her right lung removed.

"It would have been a shame, because both my lungs are perfectly good," said Smith, 71. "Plus, one of the doctors even warned that after the surgery I might still cough!"

Smith's incessant coughing began in 1990, caused by a broncholith that was poking into her right bronchus and partially obstructing the airway. "I love to walk, and the cough really interfered," she said. "Also, I'm a school teacher, so it made giving lessons very difficult. It was like I had a noose around my neck."

Through the mid-1990s, her cough grew steadily worse. It became so bad that she occasionally had to reassure parents who visited her San Diego, California, classroom that she had undergone TB tests, and her cough wasn't contagious. (Smith has taught kindergarten in San Diego for many years. She received her Master's degree in special education from the University of Iowa and taught at University Hospital School until 1984.)

"Doctors always knew when I was arriving for an appointment, because they'd hear me coughing my way down the hall," Smith said. "Something had to be done--it drained me of my energy and optimism, left me hunched over and weak. Plus, I couldn't sleep…I was often up until 3 a.m., coughing, coughing.

"My family practice doctor didn't want me to have major surgery," Smith continued. "But finally, in October 1997, he recommended I go to (a world renowned medical center) for treatment."

After examining Smith and studying her medical records during a week of evaluation, doctors recommended she undergo surgery to remove the right lung. This was recommended in part because imaging had demonstrated that her broncholith appeared to be associated with a large pulmonary artery, and she was therefore at risk of suddenly bleeding to death. Resigned to her fate, but with another week of vacation still hers to use, Smith left for Iowa City to visit friends.

While in Iowa City, friends routed Smith to University of Iowa Health Care's pulmonary special procedures service, noting that Geoffrey McLennan, M.D., associate professor of Internal Medicine, was a well-known specialist who might have different treatment options for Smith to consider. True to his reputation, McLennan devised a strategy to cure Smith's coughing without invasive surgery.

View digital scans.

"When Ms. Smith came to us, we used our unique CT scan computer-generated images to perform a virtual bronchoscopy of her airways. This demonstrated clearly that her airway stone was not associated with the pulmonary artery, and would likely be coughed out rather than need to be removed," McLennan said. "This saved her a lot of unnecessary surgery and risk."

McLennan said the software used to define Smith's airway pathology was developed by UI radiologist Eric Hoffman, Ph.D., and that he and Hoffman collaborated in evaluating the software and refining it for the benefit of this type of patient.

"Also, Ms. Smith's history suggested she had mild asthma as a cause of her cough, so we simply treated that with inhaled steroids," McLennan concluded.

When interviewed for this story, Smith was in a particularly good mood, having just been told that a repeat CT scan with virtual bronchoscopy revealed the broncholith had been coughed out. "Ever since my initial appointment with Dr. McLennan, there's been steady improvement," she said. "Coming to University of Iowa Hospitals and Clinics was the turning point.

"I was absolutely amazed to find someone here who knew so much about my problem. I owe my psychological life to Dr. McLennan and his team. They have my sheer, real, genuine appreciation."

Patients and families with questions about airway obstruction problems should call the UI Health Access toll-free number listed below and ask for the Department of Internal Medicine--Pulmonary, Critical Care, and Occupational Medicine. For consultation and referral, physicians should call UI Consult.

"I was absolutely amazed to find someone here who knew so much about my problem. I owe my psychological life to McLennan and his team. They have my sheer, real, genuine appreciation."

--Gwenneth Smith