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Cough is an important defensive reflex, and is also a very common symptom that most people have experienced in their lifetime. Chronic cough refers to a cough that persists for a long period of time, usually lasting about 8 weeks or longer in adults, or four weeks in children. This affects about 5-10% of the adult population. Most patients who present with chronic cough are usually frightened, frustrated and in despair. Usually they have tried various over-the-counter medications, and even alternative medical treatments.
History and physical examination – it is important to determine the following:
- Duration of cough (days, weeks)
- Characteristics of the cough (with phlegm, dry cough)
- Triggers (environmental or occupational exposures)
- Family history (asthma, allergies)
- Risk factors (smoking)
- Intake of medication (b blockers, ACE inhibitors)
- Complete physical examination including throat, lungs, gastrointestinal
Symptoms that usually occur with chronic cough (it is important to identify signs and symptoms suggestive of a specific disease):
- Sneezing and nasal congestion
- Postnasal drip
- Sore throat and hoarseness
- Difficulty of breathing, wheezing
- If severe, vomiting and dizziness
Diagnosis – the following will help distinguish the cause of the chronic cough:
- Blood count for eosinophil
- Chest Xray and spirometry
- Chest CT scan
- Allergy testing – allergic rhinitis associated with postnasal drip is an important cause of chronic cough. Allergy testing is performed to determine the triggers and cause of chronic cough.
Diseases associated with Chronic Cough and Management
- Asthma – Cough is a common symptom of asthma. Patients have a family history of asthma and allergies. Physical examination may show wheezing. Pre- and post bronchodilator spirometry is done on these patients, and some provocation studies may be needed. For patients with chronic cough associated with asthma, inhaled corticosteroids is the treatment of choice.
- GERD (Gastroesophageal Reflux Disease) – Gastroesophageal reflux is one of the more common causes of persistent cough. Also called “heartburn”, patients complain of cough, belching, and a sour taste in the mouth. Proton pump inhibitors are the mode of treatment used. Lifestyle modification is advised, including avoidance of smoking, spicy food, oily food and alcohol.
- Upper Airway Cough Syndrome – is also called Post-nasal drip syndrome. Patients complain of throat itchiness, post-nasal drip, nasal congestion and hoarseness. This is usually associated with allergic rhinitis, and sinusitis. Empiric therapy includes antihistamines and decongestants.
- Medication induced cough – Some medications can cause chronic cough, and these include b blockers and ACE inhibitors. It is usually a non-productive cough presenting with an itchy sensation in the throat, occurring within one to two weeks of intake by these agents. It typically resolves upon discontinuing therapy.
- Smoking – is a major cause of chronic cough and is linked to chronic obstructive pulmonary disease. With an increasing aging population, people may have multiple conditions causing the chronic cough. It is important to consider a multidisciplinary approach of different specialists – allergists, pulmonologists, ENT specialists, and gastroenterologists to work together in the management of patients with chronic cough.
- ERS Guidelines on the diagnosis and treatment of chronic cough in adults and children. ERS Journal 2020
- AAAAI Asthma Library
- ACAAI Allergy Symptoms