Treatment of chronic cough
A multitude of issues, such as allergies and underlying conditions such as asthma, acid reflux and more can cause chronic cough.
Ensuring an appropriate treatment is chosen for cough will involve a thorough examination and history. It is important to rule out causes of chronic cough, such as chronic rhinitis or chronic rhinosinusitis, which may involve a different treatment plan as to those presenting with an underlying condition.
Clinical Evaluation of a cough
- A detailed history including a thorough occupational history will be performed in all patients.
- Physical examination will concentrate on the sites identified as most commonly associated with cough.
- Chest radiograph and spirometry are performed as required.
- High resolution computed tomography may be of use in patients with longstanding cough in whom other more targeted investigations are normal.
- Optimal management will comprise a combination of diagnostic testing and treatment trials based on the most probable aggravator(s).
Current diagnostic protocols for chronic cough concentrate on the anatomical sites of receptors comprising the afferent limb of the human cough reflex. This approach has been termed the “anatomic diagnostic protocol”. Using a combination of history, physical examination, and laboratory investigations directed at these sites, possible causes for the cough are considered. The suspected cause can then be confirmed if the cough resolved or significantly improved after a trial of diagnosis specific treatment.
- By following the anatomic diagnostic protocol, a cause for cough can be found in almost all cases (>85%).
- Asthma, gastro-oesophageal reflux disease, and rhinitis are responsible for most cases of chronic cough in the non-smoker.
- Combination therapy may be required as persistent cough may have more than one cause (multiple causes in up to 40% of cases).
Similar to breathlessness, the diagnosis and treatment of chronic cough requires a holistic approach. The aim is able to pursue a treatment plan that is most suited to you and the underlying cause of your cough.
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