Chronic Cough Flashcards
Complications of chronic cough
headache anorexia vomiting rib pain throat pain fatigue and insomnia dysphonia urinary incontience abdominal herniation depression
When to be concerned
Coughs lasting more than 3 weeks and failed to respond should be investigated
Most commons causes of chronic cough with normal chest x-rays
Asthma
Upper airway cough syndrome (postnasal drip)
GERD
If patient is taking an ACE inhibitor, consider that first
Chronic cough presentations
3 months for more than 2 years = chronic bronchitis
Sudden onset while supine and sour taste = GERD
Constant throat clearing and thick mucus on rising from bed = postnasal drip / sinusitis
Rhinorrhhea and sneezing - allergic rhinitis or common cold
Intermittent with wheezing = asthma
Rarer causes
Fine ear hairs rubbing in eardrum or cerumen impaction can trigger cough
Diffuse crackles may indicate fibrosis
Chronic idiopathic cough
the cause remains elusive. In some cases, the precipitating cause of the cough may have disappeared, but its effect on the cough reflex may be more prolonged. An example of this might be a transient upper respiratory tract viral infection or an exposure to respiratory toxins, which can cause inflammatory neuropathic changes in the sensory nerves, thereby inducing more prolonged damage to the respiratory mucosa. Approximately 25% to 50% of patients have multiple causes of cough
Chronic Cough pathway
History Chest X-ray (PA / Lateral) to rule out masses, infiltrates, etc. CT Chest PFT (rule out COPD) Bronchoscopy (little benefit after a CT) Methacholine challenge (rule out asthma) Barium swallow 24 hour pH monitor CT Sinuses
Cough by Duration
Acute <3 weeks
Subacute 3-8 weeks
Chronic >8 weeks
Subacute cough causes
Bacterial sinusitis
asthma
URI
Post-infectious Cough
Follows a viral infection
Lasts less than 8 weeks
Chest X-ray normal
Bronchiectasis
Overproduction of secretions along with reduced secretion clearance
Functional cough
Sputum may separate into 3 layers
Chest X-ray is often abnormal
Chronic Cough Treatment
Manage underlying cause
Expectorants
Antihistamines
Opiates to depress cough reflex
Psychogenic Cough
Loud or barking / hacking cough during daytime
Associated with severe stress
Often leads to exhaustion
Higher Risk for ACE-I Cough
Women
Non-smokers
Chinese ethnicity
While it may occur at any time (even years later), often occurs in the first two weeks of therapy
