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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 counterproductive,” 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 testings 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...
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