By vgreene, 2 October, 2020 Stop triggers (eg, smoking, ACEI).1,5 Quitting smoking may ↑cough transiently5
By vgreene, 2 October, 2020 Consider options for difficult-to-tx cough: multimodal speech path, gabapentin, cough clinic referral, or clinical trial.3 F/U in 4-6 wks, per ACCP;1 ERS suggests continuing successful tx x3mo, then attempting w/d3
By vgreene, 2 October, 2020 If tests complete (spirometry, CXR, etc) & inadequate response to optimized tx trials (asthma, nonasthmatic eosinophilic bronchitis, postnasal drip, GERD, if relevant): ✓red flags,1 ✓triggers, smoking, environment (incl in athletes),2 occupa
By vgreene, 2 October, 2020 Further imaging: Don’t do chest CT if NL CXR/exam, but if no clear dx or refractory to tx, HRCT may identify subtle interstitial lung dz. Don’t do sinus CT, per ERS5
By vgreene, 2 October, 2020 If upper airway sx: Laryngoscopy not routine but could detect inducible laryngeal obstruction that could respond to cough control tx5
By vgreene, 2 October, 2020 GERD, dysmotility. If (-) w/u for acid reflux, don’t use PPIs.3 Insufficient evidence on promotility drugs, per ERS, but if chronic bronchitis refractory to other tx, could consider5
By vgreene, 2 October, 2020 If asthma or NAEB dx’d but inadequate response to inhaled steroids: Re-eval cause; then try ↑dose, consider leukotriene receptor antagonist trial; for asthma, also consider combo inhaled steroids w/ beta-2-agonist.4 Avoid triggers5
By vgreene, 2 October, 2020 R/O asthma (spirometry, methacholine challenge) & NAEB (sputum eos, FENO)—or that inhaled steroids trialed.3 If these tests all (-), don’t trial inhaled steroids3
By vgreene, 2 October, 2020 Consider 4- to 6-wk1 sequential3 tx trials for most common chronic cough causes, based on findings:1
