Chronic cough: A systematic Approach to Diagnosis and Treatment

Background
Chronic cough is defined as a cough persisting for more than eight weeks. 
This condition generates significant healthcare and economic costs.  Its is associated with a spectrum of disorders across multiple medical specialties and can provide significant challenges for effective evaluation and management.

Objective
Our objective was to identify common causes of cough in patients presenting to ENT and to develop an algorithm for management of patients with chronic cough.

Methods
A prospective study was done to identify the common causes for cough in patients presenting to the ENT department.  The following data was collected- cough duration and severity, aggravating/relieving factors, associated nasal, chest, reflux symptoms and medication usage.  Validated Hull reflux cough questionnaire was used in the study. Complete ENT/Chest examination, and chest x-ray were done on all patients.  Patients were treated based on the diagnosis with appropriate medications.  

Results
In otherwise healthy non-smoking patients with a normal chest x-ray and patients not on ACE inhibitors four most common conditions associated with chronic cough were identified namely esophageal reflux disease- GERD/LERD, Neurogenic cough, chronic variant asthma and Upper Airway Cough Syndrome (UACS).  Successful outcome was achieved in 80%.

Conclusions
The key to successful management is to be able to establish the
diagnosis and treat the underlying cause. Red flag symptoms
should be sought during consultations. Chest auscultation,
flexible nasolaryngoscope and chest x-ray are mandatory to
exclude underlying nasal, esophageal or lung pathology. A
systematic approach is required to make a correct diagnosis and
to start on appropriate treatment.

Chronic cough: A systematic approach to diagnosis and treatment