1 / 23

CHRONIC COUGH

ATENEO SCHOOL OF MEDICINE AND PUBLIC HEALTH. CHRONIC COUGH. EVELYN VICTORIA E. RESIDE, MD., FPCP., FPCCP. Section of Pulmonary Medicine The Medical City. SESSION OUTLINE. Definition of terms Etiologies Burden of illness Diagnostic algorithm Summary. DEFINITION OF TERMS. ACUTE

aderes
Download Presentation

CHRONIC COUGH

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ATENEO SCHOOL OF MEDICINE AND PUBLIC HEALTH CHRONIC COUGH EVELYN VICTORIA E. RESIDE, MD., FPCP., FPCCP. Section of Pulmonary Medicine The Medical City

  2. SESSION OUTLINE • Definition of terms • Etiologies • Burden of illness • Diagnostic algorithm • Summary

  3. DEFINITION OF TERMS • ACUTE • < 3 weeks • SUBACUTE • Between 3 and 8 weeks • CHRONIC • > 8 weeks

  4. DEFINITION OF TERMS • COUGH • A rapid expulsion of air from the lungs, typically in order to clear the lungs

  5. ETIOLOGIES • Bronchial Asthma, Cough Variant Asthma • GERD or LPR • Postnasal Drip Syndrome or Chronic Upper Airway Cough Syndrome (UACS) • Pulmonary tuberculosis

  6. DISEASE BURDEN • Among 284 cases seen: • Asthma 33.3% • UACS in 30.4% • PTB in 20.3% • GERD in 3.8%

  7. May be due to • One condition  93% of the time • Two conditions  53% of the time • Three conditions  35% of the time • Four conditions  4% of the time

  8. Clinical profile of patients with chronic cough due to asthma, UACS, GERD: • Patients complain of coughing • Patients are immunocompetent • Patients have a normal or near-normal chest Xray • Patients are nonsmokers and without significant environmental exposures • Patients are not taking an ace inhibitor

  9. THE PHILIPPINE TASK FORCE ON CHRONIC COUGH THE UNIFIED ALGORITHM: Jennifer Mendoza-Wi, MD., FPCCP. Liza Llanes-Garcia, MD., FPCCP. Camilo Roa, MD., FPCCP. Abundio Balgos, Jr., MD., FPCCP Consuelo Obillo, MD., FPCCP. Rosauro Valenzuela, MD., FPCCP. Evelyn Victoria Reside, MD., FPCCP. With contributions from Dr. Richard Irwin (Immediate Past President, ACCP)

  10. THE PHILIPPINE TASK FORCE ON CHRONIC COUGH CHRONIC UPPER AIRWAY COUGH SYNDROME: Zenaides Wi, MD., FPSO-HNS. Cesar Villafuerte, MD., FPSO-HNS. Joselito Acuin, MD., FPSO-HNS. WilliamLim, MD., FPSO-HNS. Madeleine Sumpaico, MD., FPSAII. Eileen Alikpala-Cuajunco, MD., FPSAII.

  11. THE PHILIPPINE TASK FORCE ON CHRONIC COUGH BRONCHIAL ASTHMA: Liza Llanes-Garcia, MD., FPCCP. Dina Diaz, MD., FPCCP. Camilo Roa, MD., FPCCP.

  12. THE PHILIPPINE TASK FORCE ON CHRONIC COUGH GASTROESOPHAGEAL REFLUX (GERD): Carla Sibulo, MD., FPSG. Gozaar Duque, MD., FPSG. Jaime Ignacio, MD., FPSG.

  13. THE UNIFIED DIAGNOSTIC ALGORITHM Cough ≥ 2 weeks Normal CXR History of ACE-inhibitor intake, smoking & exposure to occupational irritants History and PE Stop ACE-inhibitor for 4 wks Smoking cessation Avoid exposure Cough gone Ace-Induced Cough Smokers’ cough Or Irritant cough NO YES

  14. Cough gone Cough gone YES Treat as TB PTB Treatment Modification ON Hx of TB exposure NO YES YES AFB smears (+) Repeat Chest Radiograph PTB suspect 3 sputum AFB smears NO Initiate specific treatment NO Evaluate & treat for the Pathogenic Triad: (1) Asthma, (2) UACS and/or (3)GERD UACS, Asthma and/or GERD Response to treatment YES NO YES Optimize treatment and consider overlapping etiologies Cough gone NO

  15. Repeat Chest Radiograph Normal CXR Post-infectious Cough or Psychogenic Cough YES Order according to likely clinical possibility Sputum cytology, HRCT scans, Modified BaE, Bronchoscopy, Cardiac Studies Treat Specific Conditions Accordingly

  16. LET’S PLAY A GAME! WINNER: 10 POINTS 2ND PLACE: 9 POINTS 3RD PLACE: 8.5 POINTS 4TH PLACE: 8 POINTS

  17. DIAGNOSTIC ALGORITHM FOR CHRONIC COUGH & GERD Chronic Cough Alarm Symptoms? Y GERD Symptoms Y N Y Empiric treatment with acid suppressants Y Continue treatment Improved? N Refer to Gastroenterologist

  18. FLOW IN THE DIAGNOSIS OF CHRONIC COUGH & CHRONIC UPPER AIRWAY COUGH SYNDROME Chronic Cough and Possible Chronic Upper Airway Cough Syndrome History Physical exam Non-Allergic Rhinitis Rhinosinusitis Tonsillopharyngitis Laryngopharyngeal Reflux Allergic Rhinitis Diagnostics: Sinus Xrays, Sinus CT scan Therapeutics: Antibiotics, decongestants, mucolytics, surgery Diagnostics: History and Physical Exam Therapeutics: Antibiotics, surgery Diagnostics: Empiric therapy, 24-hr pH monitoring, Impedance measurement Therapeutics: Proton pump inhibitors Diagnostics: (+) Family history, response to empiric treatment, allergy skin tests Therapeutics: Environmental control, antihistamines, nasal steroids, immunotherapy, surgery

  19. DIAGNOSTIC ALGORITHM FOR CHRONIC COUGH AND ASTHMA

  20. SUMMARY • History and PE ! • ACE inhibitor treatment and cigarette smoking • When dealing with acute cough, rule out life-threatening conditions, exacerbations of chronic illness or environmental/occupational exposure • Non-infectious causes of subacute cough are managed in the same way as chronic cough • Initial empiric treatment of chronic cough is a combination antihistamine + decongestant

  21. SUMMARY • Stepwise approach towards the diagnosis • More than one etiology of cough can be present • If cough is due to ACE inhibitor intake, the drug should be stopped and replaced • If cough continues to persist, refer to a specialist!

  22. THANK YOU FOR YOUR ATTENTION!

More Related