Introduction
Chronic cough is a prevalent condition that affects a significant portion of the adult population. According to the research article "Chronic Cough in Adults: Make the Diagnosis and Make a Difference," chronic cough can persist for over eight weeks and is a common symptom for adults seeking medical attention outside of hospital settings. The complexity of chronic cough often requires a multidisciplinary approach for accurate diagnosis and effective management.
Understanding the Causes
The three most common causes of chronic cough include upper airway cough syndrome (UACS), asthma, and gastroesophageal reflux disease (GERD). However, multiple causes can coexist, complicating the diagnostic process. Accurate diagnosis is crucial for effective treatment and improved patient outcomes.
Diagnostic Approach
The article emphasizes the importance of a thorough diagnostic approach that includes history taking, physical examination, and minimal investigations such as chest radiographs and spirometry. The empirical trial of therapy with inhaled corticosteroids is recommended only when there is evidence of eosinophilic inflammation. For GERD, empirical therapy may be reasonable for symptomatic patients.
Red Flags and Multidisciplinary Care
Clinicians should be vigilant about red flags that necessitate urgent diagnosis. Chronic cough can arise from any part of the tracheobronchial tree, requiring coordination with various specialists, including otolaryngologists, pulmonologists, gastroenterologists, allergists, and speech therapists.
Mechanism and Neuroplasticity
Chronic cough involves a protective reflex mechanism that can become hypersensitive due to neuroplasticity. This sensitization can lead to an exaggerated cough response, similar to chronic neuropathic pain. Understanding this mechanism is vital for developing effective treatment strategies.
Management Strategies
- Smoking cessation and discontinuation of ACE inhibitors are initial steps in managing chronic cough.
- For UACS, treatment includes avoiding irritants, using nasal inhaled corticosteroids, and considering allergy testing.
- Asthma management involves spirometry and bronchodilators, with consideration for methacholine challenge tests.
- GERD management includes lifestyle modifications and acid suppression therapy.
- Nonallergic eosinophilic bronchitis may require inhaled corticosteroids and potentially oral corticosteroids.
Conclusion
Chronic cough is a common and often disabling condition. Utilizing an algorithmic approach, as outlined in the ACCP guidelines, can lead to accurate diagnosis and effective management. By focusing on specific diagnoses, such as UACS, GERD, or asthma, clinicians can improve treatment success rates.
To read the original research paper, please follow this link: Chronic Cough in Adults: Make the Diagnosis and Make a Difference.
