Chronic Cough

Question 1

Chronic Cough

define: chronic cough, acute cough, subacute cough

Answer 1

Chronic cough is defined as cough > 8 weeks

Acute cough = 2-3 weeks

Subacute 3-8 weeks

Question 2

Chronic Cough

3 most common ddx for chronic cough and typical age of dx

Answer 2

UAC (any age for allergic rhinitis)
GERD (increasing age = higher risk)
asthma (peak age dx < 5)

Question 3

Chronic Cough

H&P for chronic cough

Answer 3

History
• Onset/gradual
• URI at onset of cough?*
• Time of day (AM cough –> bronchitis; nighttime symptoms –> pulmonary edema, asthma, GERD)
• Characteristics of cough & sputum
• Use of ACE-I?*
• Associated w/ eating & choking? Environmental exposures?
• PN drip?
• Wheezing, dyspnea, chest pain or tightness?
• Smoking hx*
• GI symptoms: Heartburn? Abdominal or epigastric pain?
• Constitutional sx (fever, night sweats, unintentional weight loss)
• Travel, sick contacts
PE
• Vitals
• IPPA: inspect WOB, colour, finger clubbing. Ears, nose, throat. Listen Heart and lungs. Percuss sinuses, lungs. Palpate: lymph nodes

*Use of ACE-I, URI at onset, and cigarette smoking 3 most helpful clues for Ddx per Up to Date!

Question 4

Chronic Cough

Specific H&P for GERD

Answer 4

H&P for cough +

Swallowing difficulties? Hx hematemesis or melena stool?

Meds for heartburn relief or tx GERD? antacids, H2 blockers, PPIs?

Meds that may induce esophagitis: 
	• Abx
	• NSAIDS
	• Vit C, iron, K+ supplements 
	• Other (alendronate, quinidine) 

Alcohol use

PE:
Inspect for dental erosion
Perform abdominal assessment

Question 5

Chronic Cough

specific H&P for asthma

Answer 5

H&P for cough +

Triggers (including, URI, cold, exercise and environmental)

Nighttime symptoms

Response to Ventolin

Frequency of symptoms/week

Hospitalizations

Fmhx: allergies, eczema, asthma

Question 6

Chronic Cough

specific H&P for UAC

Answer 6

H&P for cough +

Recent URI

Hx allergies, asthma, rhinitis, sinusitis

Nasal congestion (unilateral or bilateral)

Allergy meds, use of nasal CS, saline sprays or netty pots

Question 7

Chronic Cough

Red Flags for lung CA

Answer 7

Suspect cancer if current/former smoker with:

• new onset of cough or change in “smoker’s cough”
• cough lasting >1 month after quit smoking
• hemoptysis in absence of infection

Question 8

Chronic Cough

Red Flags for GERD

Answer 8

Dysphagia 
Unintentional weight loss
Predominant upper abdominal pain
Hematemesis 
Melena
Odynophagia (painful swallowing)

Question 9

Chronic Cough

investigations

Answer 9

CXR
TBST
PFTs (asthma/COPD)
ECG (if indicated to r/o ACS)
Labs: CBC (elevated eosinophils if allergies), HIV, D-Dimer (if indicated)
NP swab, sputum collection (if indicated)