Chronic Cough

If symptoms have not improved, a nasal steroid or nasal antihistamine may be considered as well as an antibiotic for possible sinusitis. The patient that continues to present with UACS symptoms may benefit from sinus imaging in order to assist in diagnosis.

Asthma

Initial treatment that partially resolves or does not resolve the patient’s cough may lead the healthcare provider to evaluate the patient for asthma. A review of the patient’s history can determine possible allergens.

The most common allergens are pollens, house dust mites, mold spores and food. The cough may be allergy related is if the patient reports coughing primarily at night time when he/she is asleep.

The National Asthma Education and Prevention program recommends spirometry testing in the initial assessment of a patient suspected of having asthma.7 When a spirometry test proves positive for asthma, the patient should be given allergy medication and taught how to reduce allergen exposure.

GERD & NAEB

GERD is the third most common cause of chronic cough.1

Chronic irritation from stomach bile into the esophagus, larynx, or tracheo-bronchial tree leads to chronic irritation and the patient may relate having frequent heartburn or a sour taste in their mouth.

However, in fifty to seventy-five percent of patients that have a cough caused by GERD do not have the classic symptoms of heartburn or regurgitation.6 The patient should be prescribed a 6- to 8-week course of proton pump inhibitor medication and reevaluated in 1 month to see if symptoms have improved.

NAEB is another possible condition behind a chronic cough. The healthcare provider should consider collecting a sputum sample to evaluate eosinophils in a patient’s sputum. If eosinophils are present then adding an inhaled corticosteroid to the treatment plan is warranted.

Patient History

The healthcare provider should obtain a detailed medical history from the patient. Within this history, a list of current medications and allergies should to be provided.

Documentation of any history of smoking, exposure to second hand smoke, allergies and exposure to environmental irritants are important. The patient should be questioned if he has ever been diagnosed with previous lung disease or cancer. Assessments of infectious disease and current immunizations are important as well.

The American College of Chest Physicians (ACCP) provides evidence-based clinical practice guidelines that can be utilized by healthcare providers to assist in the diagnosis and management of chronic cough. The AACP recommends empiric treatment of the identified possible causes of the cough and an evaluation of the patient’s response to treatment.

Gold Standard

Diagnosis and management of chronic cough is not a simple task. Patients presenting with a cough may find that it takes time and a variety of diagnostic test and medication trials to find a cause and a solution for their cough.

The gold standard for the healthcare provider in assessing the accuracy of diagnosis and effectiveness of the management plan is the patient’s response to empiric treatment.3

In 20 percent of the cases of chronic cough, the patient may be diagnosed as having idiopathic chronic cough which means that a cause remains unclear even after extensive investigation and treatment trials.8

However, in 80 percent of the patients presenting with chronic cough, the health care provider that follows the AACP guidelines can successfully diagnosis and treat his/her patient.8

Sharon Chalmers is a professor and Karen Barrett is a Family Nurse Practitioner Student at Brenau University in Gainesville, GA.

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