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8/3/2019 3Cough Evaluation and Treatment
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1
2/6/2012 1
Chronic CoughChronic Cough----EvaluationEvaluation
and Treatmentand Treatment
Dr.Gunasekaran M.DProf. Of MedicineSRM Medical College
2/6/2012 2
IntroductionIntroduction
Subacute cough--- one lasting for more thanthree weeks; Chronic cough--- lasting more than
eight weeks
The fifth most common symptom seen in
outpatient offices
Patients often present with cough complication
This discussion provides a brief review of
common causes, evaluation techniques and
treatment of common cough syndromes
2/6/2012 3
Chronic Cough PhysiologyChronic Cough Physiology
Each cough occurs through the stimulation of a complexreflex arc.
Cough receptors exist not only in the epithelium of theupper and lower respiratory tracts, but also in thepericardium, esophagus, diaphragm, and stomach.
Mechanical cough receptors can be stimulated by triggerssuch as touch or displacement. Chemical receptors aresensitive to noxious gases or fumes. Laryngeal and
tracheobronchial receptors respond to both mechanical andchemical stimuli.
Sex-related differences in cough reflex sensitivity explainthe observation that women are more likely than men todevelop chronic cough
2/6/2012 4
Major causes of chronic coughMajor causes of chronic cough
1981 1996
Post nasal drip 47% 38% ± Upper airway cough syndrome (UACS)
Asthma 43% 14%
GER 10% 40%
Chronic Bronchitis 12% Bronchiectasis 0% 4%
Miscellaneous 6%
More than one Dx 18% 72%
2/6/2012 5
Other Causes of Chronic CoughOther Causes of Chronic Cough
Post infectious causes-- both bacterial and viral respiratory
pathogens
Complications of drug therapy
Airway disorders± Chronic Bronchitis due to its variouscauses, Bronchiectasis, Neoplasms and foreign bodies
Parenchymal lung disorders± Interstitial diseases, lung
abscess, chronic infections
2/6/2012 6
Cough and Post Nasal Drip (UACS)Cough and Post Nasal Drip (UACS)
Underlying reasons for postnasal drip include allergic,
perennial nonallergic, and vasomotor rhinitis; acutenasopharyngitis; and sinusitis
Symptoms of postnasal drip include frequent nasal
discharge, a sensation of liquid dripping into the back of the
throat, and frequent throat clearing
Clues on physical examination are a cobblestone
appearance to the nasopharyngeal mucosa and
nasophryngeal secretions
response to therapy secures the diagnosis
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