GERD/LPR
Three common manifestations of chronic cough related to GERD/LPR
Vocal changes, Throat clearing, Dysgeusia (a taste disorder characterized by a persistent, distorted sense of taste, where foods often taste metallic, sour, bitter, or foul), Acid reflux, Regurgitation
Timing of cough after initiation of ACEI
Hours to months after starting medication
As the most common cause of chronic cough in the US, this condition encompasses which 3 upper airway abnormalities?
Chronic allergic rhinitis, chronic non-allergic (vasomotor) rhinitis, chronic rhino-sinusitis.
These are the 3 most common lower airway causes for cough
1. Asthma
2. COPD
3. Non-Asthmatic Eosinophilic bronchitis
Define Chronic Cough (In Adults and Children)
What is Cough lasting longer than 8 weeks in Adults and 4 weeks in children
Smoking cessation, weight loss, Elevation of HOB, avoid food triggers, avoid eating before bed
These are two other Non-ACEI medications that can cause cough
Opioids, Januvia (sitagliptin) and statins
These are two empiric treatment modalities recommended for upper airway cough syndrome.
Antihistamines (can be limited by SE like dry mouth, drowsiness), nasal corticosteroids.
Three infectious causes for chronic cough
1. Pertussis
2. Sarcoidosis
3. Histoplasmosis
4. Tuberculosis
Chronic cough can increase the risk for these two comorbid conditions
What are anxiety and depression
DAILY DOUBLE!
The original Program Director for the St. Rita's Family Medicine Residency Program
Dr. Lisa Casey
Prevalence of ACEI related cough in US
5-30% of patients reportedly develop cough on ACEI. 25-50% of these patients will have spontaneous resolution of cough if medication is continued.
Three common symptoms (other than cough) of upper airway cough syndrome
Rhinorrhea, nasal congestion and throat clearing.
Don't miss these three serious causes for chronic cough...
1. Chronic Heart Failure
2. Cancer of the larynx/bronchus/lung
3. Pulmonary Fibrosis
The initial workup for chronic cough
History- identification of triggers and RED flags
Physical examination
CXR and spirometry if no cause identified on H+P
8-12 week trial of PPI
Mechanism for cough with ACEI use
ACEI prevent the degradation of bradykinin and substance P, leading to bronchoconstriction and cough.
The 100 Day Cough
Pertussis
DAILY DOUBLE!!
6 of 8 of the Leopold and Eiden sons
Ben, Marco, Jack
Grant, Noah, Luke, Evan, Camden
Six RED FLAG symptoms in patients with cough
Dysphagia, Hemoptysis, Hoarseness, New/worsening cough in pt >45 with smoking hx, dyspnea, recurrent pneumonia, vomiting, weight loss, night sweats
Obstructive Sleep Apnea
These treatment modalities are commonly used for chronic refractory cough (name 2)
Speech therapy, CBT, gabapentin, Amitriptyline. Chronic use of ICS for refractory cough not recommended
DAILY DOUBLE!!
The State Bird and State Flower of OHIO. Extra points for State Tree....
Cardinal and Carnation. BUCKEYE!
This is the definition of non-asthmatic eosinophilic bronchitis
Corticosteroid responsive chronic cough in a non-smoking patient with eosinophilic inflammation of the respiratory tract without signs of variable airway obstruction or airway hyper-responsiveness. CHEST recommends 2 months of ICS as first line tx in adults.
Don't miss these serious causes of chronic cough in children (name 3)
Cystic fibrosis, bronchiectasis, foreign body inhalation, chronic aspiration disease