Outpatient / Pulmonology
Chronic Cough
# Chronic Cough
Acute < 3 weeks; Subacute 3-8 weeks; Chronic >8 weeks
Intake
-- Onset: *** Acute < 3 weeks; Subacute 3-8 weeks; Chronic >8 weeks
-- Timing: *** al day, at night, lying flat
-- Triggers: *** smoking, exercise, ASA, dust, pollen, after eating
-- Symptoms: *** fevers/chills, sore throat, dyspnea, heartburn, sour taste, PND, sputum
-- Exam: *** wheezing, crackles, lymphadenopathy, pharyngitis, peripheral edema
-- Red Flags: *** dyspnea, fever, night sweats, weight loss, hemoptysis
-- ACEi: ***
-- Smoking: ***
-- Previous Treatments: *** albuterol, fluticasone, ipratropium, PPI, benzonatate, OTCs - Benadryl, dextromethorphan
DDx:
-- Most common chronic - Upper Airway Cough Syndrome (post-nasal drip), Asthma, GERD, allergic rhinitis, Non-allergic eosinophilic bronchitis
-- Others - CHF, walking PNA, ILD, TB, cancer
-- More acute - bacteria/viral PNA, PE, COPD
Plan:
-- Imaging: CXR to rule out PNA, lung cancer, ILD
-- Meds: *** OTCs - Mucinex (guaifenesin), Robitussin (+ dextromethorphan), Benadryl; can add benzonatate as next step, codeine if severe
-- If c/f GERD - Trial PPI (20mg omeprazole) 30 mins before AM meal for min 8 weeks
-- If c/f Asthma - PFTs; inhaled steroids (fluticasone, budesonide, mometasone); albuterol PRN; next can add ipratropium nasal spray (Atrovent)
-- CT Chest if all of the above does not help or lead to a diagnosis
Template coming soon!
Patient Guidance and Information
Workup and Management After First Visit for Chronic Cough
The most common cause of a chronic cough that lasts more than a few weeks is upper airway cough syndrome (also known as a post-nasal drip) which is a lingering cough after a viral infection. Other common causes include acid reflux (GERD) or asthma.
We believe your chronic cough is due to ***.
However, we can get a chest X-Ray to rule out more serious conditions.
In the meantime, to help with your symptoms, we can trial ***.
Over-the-counter medications you can also use include Mucinex (guaifenesin), Robitussin (includes dextromethorphan), Benadryl (diphenhydramine), and intranasal treatments like nasal saline or steroids (Flonase).
Let’s plan to touch base in *** weeks to see how your symptoms are doing. Depending on how long your symptoms persist, we may choose to trial other medicines or pursue further testing.
Please let us know if at any point you develop shortness of breath, fevers, night sweats, unexpected weight loss, or are coughing up blood.
If You Remember Nothing Else
Chronic cough is defined by a cough that lasts for more than 8 weeks. Workup for a chronic cough should begin with a chest xray to rule out serious diagnoses like lung cancer, ILD, or pneumonia. The most common causes of chronic cough are upper airway cough syndrome (previously known as post-nasal drip), GERD, and asthma. Red flags include dyspnea, fever, night sweats, weight loss, and hemoptysis. Treatments can be tailored to the most likely etiology, and can be advanced stepwise. Focus on over the counter expectorants and anti-tussives.
Clinical Pearls
- ACE inhibitor can cause cough up to 6 months after starting and will usually resolve within 3 months of stopping
Trials and Literature
Other Resources
- Clinical Problem Solvers - Chronic Cough Schema
Tweetorials
Video
