By vgreene, 2 October, 2020 If cough hypersensitivity (cold air, perfume, smoke, bleach) manage exposures3
By vgreene, 2 October, 2020 Hx obstructive airway dz. Chronic bronchitis:4 Stop smoking/exposures; insufficient evidence for abx, bronchodilators, mucolytics, etc;4 optimize COPD or asthma tx. Bronchiectasis: Use airway clearance techniques5
By vgreene, 2 October, 2020 If smoking or drug effect (ACEI, sitagliptin,1 bisphosphonates or CCBs may worsen reflux; prostanoid eye drops3): D/C ≥4wk then reassess.1 Ceasing smoking may transiently ↑cough3
By vgreene, 2 October, 2020 Consider COVID-19 (wet or dry cough), consider pertussis. ✓hx/ex, incl smoking, triggers, environment1 (incl in athletes2) occupation, travel, ✓red flags (hemoptysis, SOB, systemic sx, etc),1 r/o life-threatening dz (severe COPD/asthma, HF,
By vgreene, 2 October, 2020 Consider 4- to 6-wk1 sequential3 tx trials for most common chronic cough causes, based on findings:1
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 pr
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
