CHRONIC COUGH (FRIDAY WEEK 2, 19/09/16)

Deff : cough that persists for longer than 8 weeks

Causes :

1. Postnasal drip Postnasal drip occurs when secretions from the nose drip or flow into the
back of the throat from the nose. These secretions can irritate the throat and trigger a cough.
Postnasal drip can develop in people with allergies, colds, rhinitis, and sinusitis.

Signs of postnasal drip include a stuffy or runny nose, a sensation of liquid in the back of the throat,
and a feeling you need to clear your throat frequently. However, some people have so-called "silent"
postnasal drip, which causes no symptoms other than a cough.

2. Asthma Asthma is the second most frequent cause of chronic cough in adults, and is the
leading cause in children. In addition to coughing, you may also wheeze or feel short of
breath. However, some people have a condition known as cough variant asthma, in which
cough is the only symptom of asthma. (See"Patient information: Asthma treatment in
adolescents and adults (Beyond the Basics)".)

Asthma-related cough may be seasonal, may follow an upper respiratory infection, or may get worse
with exposure to cold, dry air, or certain fumes or fragrances.

3. Acid reflux Gastroesophageal reflux, also known as acid reflux, occurs when acid from
the stomach flows back (refluxes) into the esophagus, the tube connecting the stomach and
the throat. Gastroesophageal reflux disease (GERD) refers to symptoms caused by acid
reflux. Many people with cough due to acid reflux have heartburn or a sour taste in the mouth.
However, some patients with GERD have cough as their only symptom. (See "Patient
information: Acid reflux (gastroesophageal reflux disease) in adults (Beyond the Basics)".)

4. Other causes A number of other conditions can lead to chronic cough. These include:

a. Respiratory tract infection An upper respiratory infection such as a cold can

cause a cough that lasts more than eight weeks. This may be due to postnasal drip
(as described above), or to irritability in the airways that developed as a result of the
infection. Many people with a chronic cough after a respiratory infection respond to
treatment for postnasal drip or cough variant asthma. (See'Postnasal drip' above.)

Sometimes bacterial tracheobronchitis or bacterial sinusitis can develop following a viral upper
respiratory tract infection. In almost all cases of bacterial tracheobronchitis, patients will have a cough
that produces sputum. The sputum is colored from light yellow to dark green or even brown. Likewise,
in almost all cases of cough from bacterial sinusitis, patients will have sinus congestion and the nasal
secretions that drip or flow into the back of the throat are similarly off-colored. If such colored sputum
or postnasal drip continues unimproved for more than 10 to 14 days, antibiotics may be needed to
treat the infection. (See"Patient information: Acute bronchitis in adults (Beyond the
Basics)" and "Patient information: Acute sinusitis (sinus infection) (Beyond the Basics)".)

b. Use of ACE inhibitors Medications known as angiotensin converting enzyme

(ACE) inhibitors, which are commonly used to treat high blood pressure, cause a
chronic cough in up to 20 percent of patients. The cough is usually dry and hacking.
Switching to another medication often improves the cough over the course of one to
two weeks.
 c. Chronic bronchitis Chronic bronchitis is a condition in which the airways are
irritated, causing you to cough, sometimes raising phlegm. Most people with chronic
bronchitis are current or past smokers. (See "Patient information: Chronic obstructive
pulmonary disease (COPD), including emphysema (Beyond the Basics)".)

d. Lung cancer Although lung cancer can cause coughing, very few people with a
chronic cough have lung cancer. Cancer is possible, however, especially if you are a
smoker and your cough changes suddenly, you begin to cough up blood, or if you
continue to cough more than one month after quitting smoking. (See "Patient
information: Lung cancer risks, symptoms, and diagnosis (Beyond the Basics)".)

e. Eosinophilic bronchitis A special type of inflammation in the airways called

eosinophilic bronchitis can cause a chronic cough. This is diagnosed when your
breathing tests show no evidence of asthma, but your phlegm or airway biopsy shows
cells called eosinophils. Eosinophilic bronchitis is much less common than asthma.

Diagnosis :

Lung imaging If you are a current or former cigarette smoker, or if you have other medical
conditions that can affect the lung, a chest X-ray or even a chest CT scan may be done.

Lung function tests If asthma is suspected but cannot be confirmed, the clinician may perform
lung function tests that measure the pattern of air flow into and out of the lungs.

Acid reflux testing To confirm a diagnosis of acid reflux, a test may be done to measure the acid
level of fluid in the esophagus. This test is called a pH probe. In some people, a test called upper
endoscopy will be done to look for irritation of the esophagus and to obtain a biopsy of the
esophagus.

Treatment :

Postnasal drip A cough related to postnasal drip may improve with the use of a decongestant,
nasal or oral antihistamine, nasal glucocorticoid, or a nasal spray that contains ipratropium. The best
treatment (or combination of treatments) depends upon your symptoms and medical history. The
following are some examples of how these medications may be used:

If you have postnasal drip from a cold Antihistamines that are taken as a pill, such as
chlorpheniramine (brand name: Chlor-Trimeton) or clemastine (Tavist, Dayhist), may help, but can
cause side effects such as drowsiness and drying of the eyes, nose, and mouth. Most of these are
available over the counter. Decongestants such as pseudoephedrine can improve nasal congestion,
make it easier to blow ones nose, and thus lessen post nasal drip. Most drugstores in the United
States carry pseudoephedrine behind the counter, so you must request it from the pharmacist (a
prescription is not required). The nasal spray ipratropium bromide (Atrovent, available without a
prescription) can also help relieve runny nose, postnasal drip, and sneezing associated with a cold.

If you have postnasal drip from allergies (hay fever) Nasal glucocorticoids can be used to
help reduce nasal inflammation, postnasal drip, and cough. Some are available over-the-counter in
the United States (sample brand names: Flonase Allergy Relief, Rhinocort Allergy), while others
require a prescription.
Oral antihistamines such as loratadine (Claritin), fexofenadine (Allegra), or cetirizine (Zyrtec), are also
effective for allergic postnasal drip and they are available without a prescription. They are less likely to
cause sleepiness than older generation antihistamines such as chlorpheniramine or
diphenhydramine. Nasal antihistamine sprays such as azelastine (Astelin) can also relieve postnasal
drip.

All three of these forms of treatment (nasal glucocorticoids, oral antihistamines, and nasal
antihistamines) can be tried alone, or they can be used in combination if needed.

Cough variant asthma If your cough is due to asthma, you will be given the standard treatment
for asthma, which includes an inhaled glucocorticoid such as fluticasone (Flovent), budesonide
(Pulmicort), or beclomethasone (QVAR). You may also be prescribed an inhaled bronchodilator such
as albuterol (ProAir, Ventolin, or Proventil) if you have wheezing or shortness of breath. The
glucocorticoid decreases inflammation of the airways while the inhaled bronchodilator opens up the
airways.

Acid reflux Cough due to acid reflux may respond to the following lifestyle changes:

Avoid substances that increase reflux, such as high fat foods, chocolate, colas, red wine, acidic
juices, and excessive alcohol
Avoid eating for two to three hours before lying down
Elevate the head of the bed six to eight inches
Lose weight, if you are overweight
Stop smoking

In addition, you may be given a medication to slow the production of acid in your stomach, called a
proton pump inhibitor. Examples of proton pump inhibitors include omeprazole (Prilosec),
esomeprazole (Nexium), and lansoprazole (Prevacid). It may take eight or more weeks of treatment
before your cough improves. If your cough does not improve during this time, further testing may be
recommended.

Eosinophilic bronchitis Eosinophilic bronchitis is treated with inhaled glucocorticoids. These

medications are also used for asthma and work to decrease inflammation in the airways. Examples
include budesonide (Pulmicort) and fluticasone (Flovent).

Cough suppression If, after a thorough evaluation, the cause of your cough cannot be
determined and the cough persists, a medication that suppresses your cough may be recommended.
Possible options include:

Non-prescription cough medicines that contain dextromethorphan (Delsym) may help suppress
the cough reflex.
Benzonatate (Tessalon) is a prescription medication that may be recommended if
dextromethorphan is not helpful.
Codeine and hydrocodone are prescription narcotic medications that can be added to cough
syrup; these may be tried if other treatments have not been effective. However, both
medications can cause you to feel sleepy and should not be used while working or driving.

CROUP = BARK
PERTUSIS = WHOOP