Chronic Cough

Chronic Cough is here defined as lasting over 3 weeks without any improvement at all. It could be going on for months. Here we present the clinician’s condensed thought process when face-to-face with patients; see also Chronic Cough — Full Text for more in-depth discussion.

Causes of Chronic Cough

Not From the LungLung Diseases
โ€ข Allergic Rhinitis (Allergies; Hay Fever) #
โ€ข Chronic Sinusitis
โ€ข Esophageal Reflux (GERD) (Heartburn) #
โ€ข Hypertension medication (โ€œACE-Inhibitorsโ€)

  #  =  Conditions which can sometimes go away & then recur  [as opposed to an ongoing โ€œcoughโ€]
โ€ข Asthma #
โ€ข Post-Viral Bronchospasm
โ€ข Pertussis
โ€ข Tuberculosis (TB)
โ€ข Certain Lung Infections (fungi, etc.)
โ€ข Chronic Bronchitis #
โ€ข Heart Failure
โ€ข Interstitial Lung Disease
โ€ข Hypersensitivity Pneumonitis #
โ€ข Uncommon Diseases of Lung or Trachea
โ€ข Lung Cancer  

All of the Lung Diseases above can occasionally cause shortness of breath (SOB), a potentially-serious symptom.  See link for definition.  If thereโ€™s SOB, we know thereโ€™s a lung disease, some of which can eventually be fatal; see symptom topic Shortness of Breath.

STEP #1 —-  Consider most common causes; if likely, give treatment trial if:

  • Patient hasย  Nasal symptoms (runny nose, congestion, especially sneezing) ย โ†’ a trial of allergy medicine for presumed Allergic Rhinitis.
  • Patient has Heartburn (sour taste in throat) ย โ†’ trial of antacid medicine for Esophageal Reflux.
  • Patient has just begun an ACE-Inhibitor for Hypertension ย โ†’ change the medication!!!
  • Lung Exam suggesting Bronchospasm (wheezing or other sounds of bronchospasm heard by stethoscope ย โ†’ a trial of medicine for Asthma. (also helps Post-Viral Bronchospasm)ย  If patient a Smoker, may also try similar medications for diagnosis of Chronic Bronchitis.
  • Bursts (paroxysms) of coughing, followed by vomiting ย โ†’ย  may be Pertussis (tests not so useful; treatment not so useful once 2 weeks have gone by)
  • None of Above:ย  Test Peak Flow, give asthma treatment in office, repeat Peak Flow.ย  If improved, trial of medicine for Asthma
  • Chest X-Ray if:ย  fever, night sweats, coughing up blood, to rule out TB or other Lung Infections
  • If none of above, or if treatment trials don’t helpโ€ฆ

STEP #2  (None of Above, OR Treatment Trials No Help)  —  Chest X-Ray (CXR)

STEP #3  —  Normal CXR, & have tried different Treatment Trials without success

SPECIAL CASEHypersensitivity Pneumonitis (HP)

  • Episodes of cough, shortness of breath, maybe fever / nausea that last 4 hours to a few days, go away, & come back, repeatedly
  • If patient is a farmer, or has other job / hobby exposed to various dusts of animal or plant material, refer to Pulmonologist (mentioning this condition specifically)
  • See link above for causes

STEP #4 — Everything Normal (CXR, PFTs, “High-Res CT”), No Symptoms above, & Nothing Helps

  • Refer to a Specialist
    • Pulmonologist — if we think lung diseases most likely);
    • Ear-Nose-Throat (ENT; Otorhinolaryngologist) — if we think Upper Airway Cause; and/or
    • Gastroenterologist — if we think GERD, and treatment doesn’t help

See Chronic Cough โ€” Full Text for more in-depth explanations and discussions.

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