Algorithms for cough evaluation typically used in specialist clinics range from sequential trials of empirical treatment99 to exhaustive diagnostic testing in all cases before any trial of treatment.100 Only one study has explored the cost efficacy of such diagnostic cough algorithms.193 The “investigate all then treat” approach was the most expensive, but with the shortest time to success compared with sequential trials of empirical treatment.
The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual. A primary care provider (PCP) such as a family practitioner or internist may initially diagnose and treat a persistent cough.
Most cases of troublesome cough reflect the presence of an aggravant (asthma, drugs, environmental, gastro-oesophageal reflux, upper airway pathology) in a susceptible individual. High resolution computed tomography may be of use in patients with chronic cough in whom other more targeted investigations are normal.
A particular strain of bacterial pneumonia, called Mycoplasma, may cause a chronic cough with fatigue, weakness, shortness of breath, and sputum production. This infection is sometimes referred to as “walking pneumonia,” and commonly affects young and healthy people. Sinus problems and postnasal drip also are causes of chronic cough with mucus. This condition can be difficult to detect.
There is a dose response, and maximum cough reflex suppression occurs at 60 mg and can be prolonged.27 Care must be taken in recommending dextromethorphan at higher doses since some combined preparations contain other ingredients such as paracetamol. Acute viral cough is almost invariably benign and prescribed treatment can be regarded as unnecessary.
To adequately perform a trial of empiric PPI therapy for these patients, high doses of twice-daily PPIs for 2-3 months should be provided. Nonetheless, even this regimen fails to resolve cough in 50-75% of patients.
Chronic cough is not a disease in itself, but rather a symptom of an underlying condition. Chronic cough is a common problem and the reason for many doctor visits. Chronic cough may be prevented by not smoking, and managing medical problems such as asthma, postnasal drip, GERD, and getting vaccinated against whooping cough. Chronic obstructive pulmonary disease (COPD), bacterial sinusitis, lung cancer – all may announce their presence with a cough. And, of course, there’s the infamous smoker’s hack.
It may be a pharyngeal neuropathy caused by an infection, an underlying inflammatory condition, or GERD that rises into the pharyn-geal region. We will have to determine the etiology of the neuropathy as well as develop diagnostic and treatment algorithms for it.
- A 52-year-old man complained to his family physician (FP) about hoarseness and a chronic cough that had been bothering him for the past 6 months.
- Asthma is a disease of the airways, resulting in difficulty breathing or wheezing often characterized by abnormal breathing tests.
- The recommendations for specialist clinics in this document will therefore comprise a review of the published evidence and the clinical experience of the Guideline Development Group.
- If you are a smoker, get help to quit smoking.
“What’s the connection between acid reflux and coughing?.” Medical News Today. MediLexicon, Intl., 19 Feb. 2017. Web. Visit our Acid Reflux / GERD category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Acid Reflux / GERD. Acid reflux can lead to heartburn and difficulty eating but it can also result in a sore throat.
The findings on high resolution computed tomography (HRCT) scanning of the lung have been reported in a group of 76 young adults with a common cold.24 No important pulmonary changes were reported which is consistent with the normal findings usually reported on examination of the lower respiratory tract. Acute cough with fever, malaise, purulent sputum, or history of recent infection should be assessed for possible serious acute lung infection.
Not all infections of the airway and lung are contagious but many are. When having a respiratory infection, remember to cover your nose and mouth with a tissue when coughing or coughing to your upper sleeve.
Thus far, there have only been a small number of studies of this medication, only one of which addressed the management of patients with cough and GERD. In a study presented at last year’s American College of Gastroen-terology meeting, my colleagues and I retrospectively reviewed our experience using gabapentin to treat patients referred to our tertiary care esophageal center for chronic cough. In this study, we used gabapentin starting at low doses (usually 100 mg at night) and titrating up to 300 mg in most patients and as high as 900 mg or more in a few patients. Approximately 75% of patients experienced at least a 50% subjective improvement in cough, irrespective of their pH findings.
The base represents the population with an upper respiratory tract infection (URTI), some of whom will suffer from acute cough. Level 2 represents all those suffering from acute cough. Level 3 is the proportion of those suffering from acute cough who reach the threshold of severity of cough to trigger the purchase of a cough medicine. Level 4 is the proportion of those suffering from acute cough who reach the threshold of severity of cough to trigger a GP consultation.
When the symptoms of asthma flare up suddenly, it’s known as an asthma attack. Less common causes of chronic cough include non-infectious bronchitis unrelated to asthma and laryngeal reflux (acid back-up into the throat and voice box). Treatment of the causes of cough can often be an effective treatment strategy.