By vgreene, 2 October, 2020 Esophageal dysmotility. Reflux & aspiration can cause voice change, nasal sx, dysgeusia.3 Tests incl: endoscopic &/or video fluoroscopic swallow eval, Ba esophagram/swallow, per ACCP.1 ERS notes Ba swallow has poor sensitivity.3 Insufficient evidence on p
By vgreene, 2 October, 2020 Don’t trial inhaled steroids if spirometry/methacholine challenge show no asthma & sputum eos & FENO (-) for eosinophilic inflammation, per ACCP.9 ERS suggests that pts w/ fixed airflow obstruction trial inhaled steroids + long-acting bronchodilator combo
By vgreene, 2 October, 2020 NAEB:8 ✓sputum eos, FENO, allergy eval,1 avoid triggers3—or empiric tx of inhaled steroids1 (hi-dose, per ERS3). FENO thresholds uncertain for chronic cough, per ERS.3 If incomplete response to inhaled steroids (may take 1mo3), re-eval cause; &uarr
By vgreene, 2 October, 2020 Asthma (incl cough variant): ✓spirometry pre/post-BD, methacholine challenge, allergy eval—or empiric tx w/ inhaled steroids.1,8 If incomplete response, re-eval causes, ↑dose, consider leukotriene receptor antagonist trial (2- to 4-wk trial in
By vgreene, 2 October, 2020 Postnasal drip/upper airway cough syndrome: Consider nasopharyngoscopy, sinus imaging, allergy eval, or empiric tx, per AACP;1 ERS recommends against sinus CT. Tx w/ 1st-gen3 antihistamine + decongestant1,3
By vgreene, 2 October, 2020 If cause unclear, ✓CXR, spirometry3 (selectively CT,1,3 occupational eval, bronch, etc1) & consider 4- to 6-wk1 sequential3 tx trials for most common causes: asthma, nonasthmatic eosinophilic bronchitis (NAEB), postnasal drip, GERD1/esophageal dysm
By vgreene, 2 October, 2020 If pertussis strongly suspected based on clinical picture (less severe, typical “whoop” less freq in adolescents/adults), strongly consider tx awaiting test results7
By vgreene, 2 October, 2020 Consider TB in endemic area/hi-risk pt, even if CXR NL,1 consider sputum AFB3
By vgreene, 2 October, 2020 If immunocompromised w/ CXR(-) & common cough causes excluded, test for dz assoc w/immunocompromise6
