instruction: hello doctor I am 19 years old and have had acid reflux for the past five years I have had a cough and whistling sound wheezing with it for five years and over the past few months I have had rattling in my chest the doctors cannot hear the rattling but I feel it mostly when I lay down in addition to the rattling the cough has gotten worse it is much more of a dry cough and it burns also for the past five years it feels like it is hard to breathe but the doctor say my lungs and says it sound clear an ray was also performed a few weeks ago and they said the results were normal what could cause this my biggest fear is chronic bronchitis I am having another endoscopy soon but would a bronchoscopy be better
output: hello from your history it is very clear that you are suffering from too many problems in your teenage first thing I want to clarify is you are having morbid obesity also you suffer from chronic gastroesophageal reflux disease I herd so you are having dry cough for such a long duration the current symptoms you suffer are suggestive of bronchial asthma herd is the aggravating factor for your dry cough the most important investigation to rule out asthma is spirometry also called as pulmonary function test put obesity is making all symptoms worse so you should also concentrate on weight reduction and regular exercise if put is suggestive of asthma you need definitive inhaler treatment to keep your asthma under control chest ray may appear normal but dry cough for such a long duration again suggest asthma priority should be given for weight reduction allergy to dust herd and obesity put or spirometry ace absolute eosinophil count blood test bronchial asthma herd bronchial asthma inhaled corticosteroids through metered dose inhalers antacids for reflux and weight reduction for obesity avoid spicy food needs regular monthly follow up with your doctor to keep your asthma under control