1 2/6/2012 1 Chronic Cough Chronic Cough-- --Evaluation Evaluation and Treatment and Treatment Dr.Gunasekaran M.D Prof. Of Medicine SRM Medical College 2/6/2012 2 Introduction Introduction Subacute cough--- one lasting for more than three weeks; C hronic cough--- lasting more than eight weeks The fifth most common symptom seen in outpatient offices Patients often present with cough complication This discussion provides a brief review of common causes, evaluation techniques and treatment of common cough syndromes 2/6/2012 3 Chronic Cough Physiology Chronic Cough Physiology Each cough occurs through the stimulation of a complex reflex arc. Cough rece ptors exist not only in the epithelium of the upper and lower res piratory tracts, but also in the pericardium, esophagus, diaphragm, and stomach. Mechanical cough receptors can be stimulated by triggers such as touch or displacement. Chemical receptors are sensitive to noxious gases or fumes. Laryngeal and tracheobronchial receptors respond to both mechanical and chemical stimuli. Sex-related differences in cough reflex sensitivity explain the observation that women are more likely than men to develop chronic cough 2/6/2012 4 Major causes of chronic cough Major causes of chronic cough 1981 1996 Post nasal drip 47% 38% ± Upper airway cough syndrome (UACS) Asthma 43% 14% GER 10% 40% Chron ic Bronchi tis 12% Bronchiectasis 0% 4% Miscellaneous 6% More than one Dx 18% 72% 2/6/2012 5 Other Causes of Chronic Cough Other Causes of Chronic Cough Post infectious cause s-- both bacterial and viral respirator y pathogens Complications of drug therapy Airwa y disorders± Chronic Bronch itis due to its various causes, Bronchiectasis, Neoplasms and foreign bodies Parenc hymal lung disorders± Interstitial diseases , lung abscess, chronic infections 2/6/2012 6 Cough and Post Nasal Drip (UACS) Cough and Post Nasal Drip (UACS) Underlying reasons for postnasal drip include allergic, perennia l nonallergic, and vasomotor rhinitis; acute nasophar yngitis; and sinusitis Symptoms of postnasal drip include frequent nasal discharg e, a sensation of liquid dripping into t he back of the throat, and frequent t hroat clearing Clues on physical examination are a cobblestone appearance to the nasopharyngeal mucosa and nasophryngeal secretions response to therapy secures the diagnosis