UCSF Voice and Swallowing Center University of California, San Francisco [email protected]Essential work-up of chronic cough VyVy N. Young, MD Associate Professor, Dept of Otolaryngology – Head and Neck Surgery UCSF Voice and Swallowing Center Disclosure None personally Spouse: - Olympus America Inc. (consultant) - Instrumentarium (royalties/holder of intellectual property rights) - Freundenberg (consultant) - Reflux Gourmet LLC (stock shareholder)
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UCSF Voice and Swallowing CenterUniversity of California, San Francisco
Or something else… Video courtesy of Dr. JP Giliberto
UCSF Voice and Swallowing Center
Essential work-upFirst visit
If allergy/sinus symptoms: - Maximal medical tx x 4 weeks- Saline rinse, nasal steroids,
antihistamines, possible abx
Consider empiric acid suppression- At least 12 weeks- PPI 40mg daily, H2RB qhs,
alginate after meals & qhs
Then reassess 3 mos later- Cough gone:
Wean treatments
- Cough persists: Move on to other possibilities
UCSF Voice and Swallowing Center
Next stepsDepends on associated symptoms and your suspicion for underlying etiology
Potential additional workup:
Pulm referral- PFTs, chest CT, bronchoscopy, eval for Pertussis?Allergy testingSinus CT without contrastReflux testing- pH/impedance, manometry- TNE/EGD- Eval for anti-reflux surgery
UCSF Voice and Swallowing Center
Next steps
“Neurogenic cough” can be hard to diagnosis – treatment may be diagnostic and therapeutic
Superior laryngeal nerve blockNeuromodulators- Neurontin, pregabalin, TCA’s- Tramadol, baclofen
UCSF Voice and Swallowing Center
The Cough Wheel
From Ch 9 Chronic Cough, Plural Publishing 2019, TL Carroll Ed
Where to start?
How long to try?
One at a time? All at once?
UCSF Voice and Swallowing Center
Summary: essential workup of chronic coughHow to know which way to go?
Don’t forget the obvious- ACE inhibitors- Hydration- CXR- TobaccoHave a logical approach- Checklist- AlgorithmBe guided by pt’s symptomsBe willing to think outside the box