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2/6/2012 1

Chronic CoughChronic Cough----EvaluationEvaluation

and Treatmentand Treatment

Dr.Gunasekaran M.DProf. Of MedicineSRM Medical College

2/6/2012 2

IntroductionIntroduction

Subacute cough--- one lasting for more thanthree weeks; Chronic cough--- lasting more than

eight weeks

The fifth most common symptom seen in

outpatient offices

Patients often present with cough complication

This discussion provides a brief review of 

common causes, evaluation techniques and

treatment of common cough syndromes

2/6/2012 3

Chronic Cough PhysiologyChronic Cough Physiology

Each cough occurs through the stimulation of a complexreflex arc.

Cough receptors exist not only in the epithelium of theupper and lower respiratory tracts, but also in thepericardium, esophagus, diaphragm, and stomach.

Mechanical cough receptors can be stimulated by triggerssuch as touch or displacement. Chemical receptors aresensitive to noxious gases or fumes. Laryngeal and

tracheobronchial receptors respond to both mechanical andchemical stimuli.

Sex-related differences in cough reflex sensitivity explainthe observation that women are more likely than men todevelop chronic cough

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Major causes of chronic coughMajor causes of chronic cough

1981 1996

Post nasal drip 47% 38% ± Upper airway cough syndrome (UACS)

Asthma 43% 14%

GER 10% 40%

Chronic Bronchitis 12% Bronchiectasis 0% 4%

Miscellaneous 6%

More than one Dx 18% 72%

2/6/2012 5

Other Causes of Chronic CoughOther Causes of Chronic Cough

Post infectious causes-- both bacterial and viral respiratory

pathogens

Complications of drug therapy

Airway disorders± Chronic Bronchitis due to its variouscauses, Bronchiectasis, Neoplasms and foreign bodies

Parenchymal lung disorders± Interstitial diseases, lung

abscess, chronic infections

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Cough and Post Nasal Drip (UACS)Cough and Post Nasal Drip (UACS)

Underlying reasons for postnasal drip include allergic,

perennial nonallergic, and vasomotor rhinitis; acutenasopharyngitis; and sinusitis

Symptoms of postnasal drip include frequent nasal

discharge, a sensation of liquid dripping into the back of the

throat, and frequent throat clearing

Clues on physical examination are a cobblestone

appearance to the nasopharyngeal mucosa and

nasophryngeal secretions

response to therapy secures the diagnosis

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