Chronic Cough

Question 1

chronic cough

Answer 1

over 8 weeks

Question 2

Chronic >8 weeks, warrant a ____ and if it is normal most common causes include: __, __, __, __ bronchitis

Answer 2

• Chronic >8 weeks, warrant a chest x-ray and if CXR is normal most common
causes: asthma, rhinosinusitis, GERD, eosinophilic bronchitis

Question 3

worrisome associated symptoms of chronic cough

Answer 3

systemic fever, night sweats, chills, weight loss, lassitude, fatigue, dyspnea, hemoptysis.

• history of cancer, lund disease, abnormal chest exam, finger clubbing, lymphadenopthy, hepatomegaly.
• abnormal chest x ray

Question 4

outline the chronic cough scheme (hint- first branch is CXR normal vs abnormal)

Answer 4

Question 5

• In most cases, chronic cough is due to a ___
condition & chest x-ray is normal
• Chronic cough in ‘never smokers’ with a normal
chest x-ray is rarely due to a ___ cause

Answer 5

• In most cases, chronic cough is due to a benign
condition & chest x-ray is normal
• Chronic cough in ‘never smokers’ with a normal
chest x-ray is rarely due to a sinister cause

Question 6

Approximately 2/3s of chronic cough referrals are female– why?

Answer 6

often because of increased cough sensitivity- capsaicin, citric or tartaric acid.

Question 7

if chronic cough has been determined to be obstructive causes (normal cxr), main treatment?

Answer 7

smoking cessation, trigger avoidacne, bronchodilator inhaler therpay

Question 8

DIFFERENTIAL DIAGNOSIS (NORMAL CXR) 3 MOST COMMON CAUSES:

Answer 8

• Lower airway (reactive airway disease/asthma, eosinophilic bronchitis, chornic bronchitis)
• Upper airway: rhinosinusitis, allergic, vasomotor, vagal stimulaiton, post nasal drip)
• Gastroesophageal reflux
• Prevalences vary in different populations

Question 9

Chronic refractory cough: persist despite approrpiate evaluation and treatment trials. may be due to ___ ___ similar to trigeminal neuralgia. the larynx is structually noramlly but has incresed __ ___ and ____ vocal cord motion.

Answer 9

may be due toNEUROPATHIC DISODER similar to trigeminal neuralgia. the larynx is structually noramlly but has incresed MUSCLE TONE and PARADOXICAL vocal cord motion.

Question 10

how does chronic refractory cough parallel chronic pain?

Answer 10

1. paresthesia
2. hypertussia
3. allotussia (normally non cough stimuli trigger cough ex/ laughing)

Question 11

management of asthma/eosinophilic bronchitis

Answer 11

• inhalted corticosteroids
• smoking cessation-couseling and pharmacotherapy

Question 12

management for vasomotor rhinitis

Answer 12

• Antihistamines/decongestants
• Nasal saline spray/rinse
• Nasal ipratropium spray

Question 13

gastroesophageal reflux management for chronic cough

Answer 13

Question 14

additional therapies outside of medicine for chronic refractory cough

Answer 14

• @ Half improve with SPT* techniques, vocal hygiene,
cough control strategies: cough avoidance & suppressive strategies

Question 15

Note: flow chart

Question 16

chronic cough summary