APPROACH TO THE CHRONIC COUGH

 

CHRONIC COUGH (more than 8 weeks)

 

 


History and Physical Exam Obvious source identified

 

Cough Resolved Stop ACE Inhibitor (4-6 weeks)

Stop Smoking (4-6 weeks)

 

Cough Persists

 

Obtain Chest Radiograph and Pulmonary Function tests

 

 

Abnormal Normal

Further work-up Minimal abnormality on imaging likely

not related to cough Cough persists

(ie small granuloma)

 

CHRONIC COUGH WITH NORMAL CHEST X-RAY/PFT

 

 


Evaluate and treat for the most common conditions

 


Post-Infectious Cough

*Observe

*inhaled versus oral steroids

 

 

 

Upper Airway Cough Syndrome ASTHMA GERD

(Rhinitis/Post nasal drip/Sinus disease) *PFTs *Lifestyle mod

*Antihistamines/ Decongestants *Inhaled steroids *PPI

*Nasal Steroids *Inhaled broncho- *H2 blocker

*Sinus imaging if no improvement dilators

*Oral steroids

Cough Persists

 

 


Evaluate for less common causes