Chronic Cough

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A chronic cough is a cough that lasts eight weeks or longer in adults, or four weeks in children. A chronic cough is more than just an annoyance. ... While it can sometimes be difficult to pinpoint the problem that's triggering a chronic cough, the most common causes are tobacco use, postnasal drip, asthma and acid reflux.
Differential Diagnosis
Non Pulmonary post nasal drip, GERD, ACE inhibitors, occult congestive heart failure
Pulmonary
Airway asthma, chronic bronchitis, bronchiectasis, neoplasm, foreign body, post viral
Parenchyma occult infection, occult aspiration, interstitial lung disease, lung abscess
Vascular early pulmonary hypertension
Pathophysiology
Definition of Chronic cough >3 weeks
Complication of Chronic cough exhaustion, insomnia, anxiety, headaches, dizziness, hoarseness, musculoskeletal pain, urinary incontinence, abdominal hernias
Cough Reflex
Afferent chemical or mechanical stimuli ͢   cough receptors in the epithelium of the upper and lower respiratory tracts, pericardium, esophagus, diaphragm, and stomach͢ afferent nerves (vagus, glossopharyngeal, trigeminal, and phrenic) ͢   cough center in the medulla.


Efferent cough center with cortical input  ͢    efferent signals travel down the vagus, phrenic, and spinal motor nerves͢    expiratory muscles  ͢    cough
Investigation
Basic
Microbiology sputum Gram stain/AFB/C&S
Imaging CXR (order inspiratory and expiratory views if foreign body aspiration or endobronchial lesion suspected)
Spirometry/PFT
Special
Sinus imaging
Methacholine Challenge
Esophageal PH Monitoring
Management
Symptom Control codeine 20 mg PO q4h PRN, dextromethorphan 20 mg PO q4h PRN
Treat Underlying cause switch to ARB if ACE inhibitor suspected as cause of chronic cough
Specific Entities
Post Nasal Drip
Pathophysiology secretions in the upper airway stimulate cough receptors within the pharyngeal or laryngeal mucosa
Causes allergic, perennial non allergic, vasomo tor rhinitis, acute nasopharyngitis, sinusitis
Diagnosis non specific findings
Treatment reduce irritant exposure, antihistamine decongestant combinations (diphenhydramine 25 50 mg PO q4 6h PRN, pseudoephedrine, ipratropium nasal spray 0.03% 2 sprays/nostril BID TID, nasal corticosteroids, nasal saline rinses BID), surgical correction for anatomical abnormalities 

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