Persistent productive cough has not stopped even after several medications. Why?

Hello doctor,

I need to get a help for my persistent cough. I have been having this for the past six months. My current medications are 100 mg of Sertraline daily for depression and anxiety.

For the past six months, I started developing a persistent, productive cough. The cough usually produces clear mucus, and sometimes has brown specs in it. At the time, I had been smoking marijuana daily for a little over a year (I do not smoke cigarettes). Thinking the cough might have something to do with that, I stopped smoking. However, after a few months went by, I was still coughing a lot throughout the day. I tried taking allergy medicine, Mucinex, and other over the counter medicine, but it did not seem to do anything.

After two months, I talked to a doctor about it. The first doctor thought it might have to do with some sort of hyper reactive airway or asthma situation. So he prescribed me an Albuterol inhaler. I used that for a few weeks but did not notice much of a change. So I saw a second doctor in person, and she thought it might have to do with allergies, so she prescribed me a Flovent inhaler and Flonase. After using both of those for a few weeks the cough still did not go away.

So I saw a different doctor in person, and she believed that it might be some form of a long lasting sinusitis, because she noticed I had pressure in my sinuses. She also did not think it was anything respiratory related because there is nothing wrong with my breathing. She gave me antibiotics for 10 days and told me to take anit-allergic medicine.

Shortly after that, I noticed I was getting some shortness of breath. It got worse for a few days in a row so I ended up going to the emergency room. At the ER, I told them about my situation and they did several tests. They checked my breathing and oxygen levels, did urine and blood tests, a chest x-ray, and did a COVID-19 test. All of these tests did not show anything wrong, so they figured the shortness of breath was due to my anxiety. I went home and tried to focus on improving my anxiety, and my shortness of breath went away, so I do believe that my shortness of breath was from anxiety.

The exact tests they did at the ER were:

1. CBC with differential.

2. Comprehensive metabolic panel.

3. Coronavirus (COVID-19) NAAT.

4. D-dimer.

5. POC group chem +8 (HGB, HCT, BMP-ICA).

6. POC Troponin I.

7. POC urinalysis dipstick.

8. POC urine pregnancy.

9. POCT rapid urine rrug screen with BUP.

10. Protime INR.

Imaging tests: ECG 12 lead, X-ray chest AP portable.

At the end of the ER visit, my oxygen saturation was 99% and respiration was "20" (not sure what units?)

However, the cough still has not gone. I talked to the doctor a few more times and was told the same thing most times that it was probably a long lasting sinus infection and the post-nasal drip from my sinuses is what causing the cough, and that I should take allergy medicine, Flonase, and do a sinus rinse every day.

However, I have been doing that for several weeks now and the cough is not getting better. I do not really feel any issues with my sinuses, it is mainly the cough that is bothering me. I still cough very frequently throughout the day. I have now had this cough for almost five months and have tried all these things and the cough still has not gone away, so that is why I wanted to reach out to an internal medicine physician specifically to try and get the treatment I need to fix this cough.

Thank you doctor,

No, I do not have any of those other symptoms. Usually, the sputum is clear but sometimes there are bits of brown or orange. I was wondering if I would need a doctor visit for HRCT and sputum test?