We’re gonna talk about chronic cough, now this is something that is defined as anybody who has at least eight weeks of cough, the first thing you want to do if this is going on is generally speaking, get a chest x-ray and rule out infectious etiology, this is a big problem if you got an infectious etiology, you’re thinking about things like tuberculosis, you’re thinking about pneumonia, this is stuff that you ought to have the physician do right off the bat to rule that out but let’s just say you’ve got a normal chest x-ray and then the other thing you want to rule out is to make sure you’re not on something called an ACE inhibitor, that’s a medication that usually ends in Aprill like captopril lisinopril enalopril ramipril, these ACE inhibitors can cause coffee increasing bradykinin and so really if somebody’s got a chronic cough that you’re trying to work out on a test, the first thing you want to do is make sure you’ve got a chest x-ray to rule out infectious problem and then look at their med list to make sure they’re not on ACE inhibitor. I would say about 30% of patients with an ACE inhibitor are gonna have some sort of a chronic dry cough, okay so once you’ve ruled these out, what are the possibilities, let’s talk about what those possibilities are so there are three possibilities that I like to look at in terms of chronic cough and the first thing I’d like to do is start off with one from the top if you will so, it’s called post nasal drip or allergic rhinitis, okay post nasal drip or allergic rhinitis.

What are the symptoms of that clearing your throat a lot, okay if you look in the back of the throat you see this thing called cobblestone inge, you’ve got itchy eyes or allergies itchy eyes, so think about all those things in terms of post nasal drip or allergic rhinitis and I would say out of all the people who have a chronic cough or what we’ve eliminated, this accounts for about 9% of that so think about that, the next time someone comes in with a chronic cough, it’s quite possible that we could be dealing with someone with post nasal drip.
So what’s the treatment for that? well you want to try to identify the things that’s causing the allergies but the treatment generally speaking is intra nasal steroids, okay so you’ve heard of things like Nasonex, you’ve heard of flonase you’ve heard of a stolen or asked to pro iris, these are all kind of intranasal steroids or antihistamines, okay the other thing that’s indicated for allergic rhinitis is singulair so that might be something else that you could use for a possible chronic cough and so if those symptoms fit that’s great, okay let’s go on to the next possibility, the next possibility is also around 9% and that instead of coming from the top down it comes from the bottom up so here you’ve got your airway but right next to your airway in fact right behind your airway is your esophagus which goes down to your stomach and if you’ve got stuff in there and you get something called gastroesophageal reflux disease it can sometimes come in and irritate that airway and cause what we call GERD.

Leave a Reply