Evaluation and treatment of chronic cough.
Chronic cough is a frustrating and common problem, resulting in significant psychological and physical sequelae as well as enormous financial costs in terms of health care expense and time lost from work. Decreased QoL and depression are common. However, using a systematic approach, including assessing whether the patient uses ACE-I and cigarettes, excluding the presence of red flags and risk factors for life-threatening diseases, and obtaining and normal chest radiograph, more than 90% of cases of chronic cough are diagnosed as being caused by UACS, asthma, or GERD. It is recommended to address these conditions sequentially, starting with UACS. Nonasthmatic eosinophilic bronchitis and pertussis infections are unrecognized by primary care providers and should be considered after UACS, asthma, and GERD have been addressed. Finally, cough hypersensitivity syndrome is a new area of research and has been hypothesized to be the underlying factor in many cases of chronic cough, regardless of the inciting factor. More clinical research is needed to further elucidate the cough reflex pathway and the factors involved in modulating its sensitivity, which may eventually lead to new antitussive therapeutics.
Division of General Internal Medicine, Harborview Medical Center, University of Washington, Box 359780, 325 Ninth Avenue, Seattle, WA 98104, USA. Electronic address: terasaki@u.washington.edu.
Genji
G
Terasaki
Division of General Internal Medicine, University of Washington, Box 356420, BB527 Health Sciences Building, Seattle, WA 98195, USA.
Douglas S
DS
Paauw
D000996:Antitussive Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003371:Cough / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors
D000996:Antitussive Agents
Chronic cough; Cough; Cough-variant asthma; Gastroesophageal reflux; Post nasal drip; Primary care; Upper airway cough syndrome