32 year old Malay man with persistent cough of 3 months (Asthma (diagnosed…
32 year old Malay man with persistent cough of 3 months
Upper airway cough syndrome
Drainage in the posterior pharynx, throat clearing, nasal discharge, cobblestone appearance of the oropharyngeal mucosa, and mucus in the oropharynx
diagnosed with spirometry
next most common
exacerbated by cold or exercise, or is worse at night.
methacholine inhalation challenge testing may be performed to con rm asthma
resolution of cough with speci c asthma therapy, a trial of inhaled bronchodilators or corticosteroids
Acid re ux can stimulate the afferent limb of the cough re ex by irritating the upper respiratory tract without aspiration or by irritating the lower respiratory tract through aspiration
3rd leading cause
Daily heartburn and regurgitation suggest a GERD-induced chronic cough
empiric trial of a proton pump inhibitor is recommended
Non-asthmatic eosinophilic bronchitis
chronic cough in patients with normal airway hyperresponsiveness, sputum eosino- philia, and no symptoms or objective evidence of vari- able air ow obstruction.
presence and activation of eosinophils and metachromatic cells in the sputum differentiate nonasthmatic eosinophilic bronchitis from classic chronic bronchitis.
ack of bronchial hyper- responsiveness in nonasthmatic eosinophilic bronchitis differentiates it from asthma
normal spirometry and respond to inhaled and systemic corticosteroids
Chronic bronchitis caused by exposure to cigarette smoke or other irritants
cause a nonproductive cough in 5 to 20 percent of patients, affecting women more often than men.
one week to six months after therapy is initiated
An angiotensin receptor blocker may be substi- tuted for the ACE inhibitor.
cough persists after an upper respiratory tract infection.
Oral or inhaled corticosteroids, ipratropium (Atrovent), or cough suppressants may be prescribed to help with sleep.
Brodetella Pertusis infection
Computed tomography should be ordered if chest radi- ography ndings suggest malignancy.
Sputum samples can be examined for the presence of cancer cells.
negative evaluation for common causes of cough should also be evaluated with computed tomogra- phy or bronchoscopy
Interstitial pulmonary fibrosis
typically have chest radiography ndings suggestive of the diagnosis (i.e., mediastinal widening caused by bilateral hilar adenopa- thy and reticular opacities
other more common disorders such as UACS and GERD should be excluded as primary or contributing causes.
Thoracic aortic aneurysm (TAA)
Bronchietasis and Chronic supprative lung disease
associated with excessive overproduction and reduced clearance of airway secretions.
associated with UACS, asthma, GERD, and chronic bronchitis
Chest radiography may demonstrate increased thickening of the bronchial wall
cystic brosis, primary ciliary dyskinesia, α1-antitrypsin de ciency); aspiration or GERD; immune de ciency; rheumatoid arthritis; ulcerative colitis; and allergic bronchopulmonary aspergillosis
Tropical filarial pulmonary eosinophilia
habitual cough is a diagnosis of exclusion.
do not cough during sleep, are not awakened by cough, and generally do not cough during enjoyable distraction
contra in pregnant women
sputum tests, modi ed barium esophagography, pulmonary function testing, high- resolution computed tomography, bronchoscopy, cardiac studies