This document discusses the evaluation and treatment of chronic cough. It outlines the steps in evaluating chronic cough which include obtaining a history, performing a physical exam, measuring cough severity and frequency, and conducting diagnostic tests and evaluations. Potential causes of chronic cough are grouped into categories such as infections, airway diseases, parenchymal diseases, tumors, foreign bodies, cardiovascular issues, gastroesophageal reflux disease, drugs, and other miscellaneous conditions. Treatment involves identifying and treating the underlying cause, and when the cause cannot be identified or treated, symptomatic treatments aimed at reducing cough are used.

1. Dr. M.A. Nazrul

2. DEFENSE
MECHANISM
EXPLOSIVE
EXPIRATION
CHARACTERISTIC
SOUND

3. 1. 2. 3.
GLOTTIC CLOSURE
INSPIRATORY PHASE EXPIRATORY PHASE

6. 04.
Measurement of severity and
frequency 02.
History and Physical
examination
Diagnostic evaluation Treatment
03.
01.

7. • Cough questionnaires
• Cough reflex
• Severe cough
complications

10. • Upper respiratory tract infection
• Allergies
• Exacerbation of COPD
• Pneumonia
• Foreign body aspiration
• Congestive cardiac failure
• Pulmonary Embolism

11. CHRONIC INFECTIONS
Bronchiectasis
Tuberculosis
Cystic fibrosis
AIRWAY DISEASES
Asthma
Eosinophilic bronchitis
Cough variant asthma
Chronic bronchitis
COPD
Chronic postnasal drip
PARENCHYMAL DISEASES
Interstitial pulmonary fibrosis
Emphysema
Sarcoidosis
TUMORS
Bronchogenic carcinoma
Alveolar cell carcinoma
Benign airway tumors
Mediastinal tumors
ASPIRATED FOREIGN BODIES
MIDDLE EAR PATHOLOGY
CARDIOVASCULAR
DISEASES
Left ventricular failure
Pulmonary infarction
Aortic aneurysm
OTHER DISEASES
Gastroesophageal reflux
disease
Laryngopharyngeal reflux
Recurrent aspiration
Endobronchial sutures
Obstructive sleep apnea
Laryngeal dysfunction
DRUGS
Angiotensin-converting
enzyme inhibitor
medications

12. • Persistent cough/Episodic cough
• Perennial/Seasonal
• Brassy/Croupy/Whooping
• Productive/Non-productive
• Nocturnal
• Early morning cough
• Cough in Supine posture
• Cough during eating

13. Routine blood tests
Chest radiograph
Sputum test
CT Thorax
Sinus imaging
Serological tests
Allergy test
PFT
Bronchoscopy
24 hr pH monitoring/Barium study/UGI Endoscopy

14. Treat the underlying cause
When the treatment of the cause of cough is not effective or not available, therapies directed at
eliminating the symptom of cough irrespective of the cause of the cough may be tried
ANTITUSSIVE- Opiates including morphine, diamorphine, and codeine
Non-opiods- Dextromethorphan, noscapine, levopropoxyphene, levodropropizine,
benzonatate
Others- Amitriptyline, Gabapentin
LOCAL ANAESTHETIC- Lidocaine aerosol
EXPECTORANT & MUCOLYTICS- acetylcysteine, carbocysteine, bromhexine, and methylcysteine
DEMULCENTS

15. Postnasal drip
Throat clearing
Nasal congestion
Hoarseness of voice
Cobblestone pharyngeal mucosa
Allergy to pollen
Imaging
Topical steroids
Antihistamines

16. Heartburn, chest pain
Hoarseness, globus sensation, sore throat
24hr ambulatory pH monitoring
PPI
Baclofen
Fundoplication

17. Productive cough
Smoking history
Airflow obstruction
Inhaled Corticosteroids
Beta agonist
Anticholinergics

18. Mucopurulent sptum
Fever, haemoptysis
Recurrent chest infections
Imaging
Chest physiotherapy
Beta agonist
Antibiotics

19. Nocturnal/Early morning cough
Wheeze
Reversible airflow limitation
Bronchial hyperresponsiveness
Eosinophilic sputum
Inhaled corticosteroids
Bronchodilators
Leukotriene antagonists