Strategies for Managing Chronic Cough

Strategies for Managing Chronic Cough

Chronic cough, or cough that persists beyond 8 weeks, has a prevalence of 9% to 33% in all age groups. Chronic cough can cause rib fractures, syncope, anxiety, physical discomfort, and embarrassment. Treating the underlying causes of chronic cough is key to  management. In some cases, it can be complicated for clinicians. Determining Causes “When trying to determine the cause of chronic cough, memorizing a list of top causes can be counter-productive,” says Kaiser G. Lim, MD, author of a recent update on chronic cough that was published in Mayo Clinic Proceedings. “Instead, it’s more effective to approach chronic cough algorithmically. Physicians should consider various factors that can irritate the laryngopharyngeal area, such as polyps, granulomas, post-nasal drip, and cigarette smoking. The laryngopharyngeal area is where there is the highest concentration of cough receptors.” Dr. Lim recommends exploring the respiratory tract below the vocal cords after the laryngopharyngeal area, considering other potential causes like bronchitis, sarcoidosis, bronchiectasis, and endobronchial tumors. “If providers consider and explore these two areas, there’s no need to memorize a list of top causes of chronic cough,” he says. He cautions clinicians to not provide purely symptom-directed treatment. Laboratory and radiographic testing should be guided by the patient history. Many intrathoracic abnormalities can be excluded with a chest x-ray, but without it, physicians can miss some types of cancer, sarcoidosis, lung collapse, and other health problems. “If a physician thinks that cough is due to airway disease,” Dr. Lim says, “then patients may mistakenly be treated for that problem without performing the necessary relevant studies.” An Algorithmic Approach When taking an algorithmic approach to chronic...

COPD: Coming to a Consensus

Approximately 24 million Americans have airway obstruction that is suggestive of COPD. With close to 125,000 annual deaths attributed to the disease, COPD now ranks as the third leading cause of death in the United States. Despite the disease’s wide scope, about 50% of patients are undiagnosed, largely because it’s underrecognized by the public. COPD progresses slowly, with early disease presenting with mild symptoms that patients learn to live with. Many COPD sufferers view their symptoms as a part of aging. Only few link them to smoking, the primary cause of the disease. Clinicians Play a Vital Role in Diagnosing COPD Despite recommendations from national guidelines, many clinicians throughout the U.S. do not utilize spirometry, an important tool in diagnosing COPD, because they feel it’s too time-consuming or expensive. This can lead to under-diagnosis, a problem commonly seen in the outpatient setting. Further complicating the issue is that many patients with COPD don’t receive a diagnosis until they are hospitalized from exacerbations that are usually triggered by infections. About 750,000 patients with COPD require hospitalizations each year. These patients tend to have poorer long-term outcomes than those diagnosed and treated effectively in the outpatient setting. Prevention of hospitalizations due to exacerbations through early diagnosis and treatment, smoking cessation, and increased awareness of COPD among patients and providers is important. 7 Key Recommendations for COPD There are several guidelines for COPD, including those from the American Thoracic Society, European Respiratory Society, American College of Physicians, and American College of Chest Physicians. In the August 2, 2011 Annals of Internal Medicine, my colleagues and I published a consensus that brings together...