You’re listening to ReachMD. This medical industry feature, titled “Clinical Assessment of Chronic Cough in Adults” is paid for and brought to you by Merck. This program is intended for health care professionals in the United States, its territories, and Puerto Rico.
Hi, I’m Dr. Peter Dicpinigaitis, professor of medicine at the Albert Einstein College of Medicine and director of the Montefiore Cough Center in New York.
I’m here today to talk about the clinical assessment of a condition that may impact some adult patients…chronic cough.1,2
Coughing is a fundamental protective reflex in response to airway irritation, but if it becomes disordered, it can lead to a persistent cough.3,4
A cough that lasts greater than 8 weeks in duration in adults is considered a chronic cough.1
The American College of Chest Physicians, or CHEST, Expert Cough Panel has provided guidance for assessing and managing patients with chronic cough using validated tools and clinical guidelines.1,5
The CHEST Panel recommends that cough frequency and severity, as well as the impact of cough on health-related quality of life, be evaluated using validated tools.1,5
In 2017, the CHEST Panel published updated clinical guidelines for cough, including chronic cough.1
The process of evaluating chronic cough may include an initial investigation to assess the patient followed by an evaluation of underlying conditions commonly associated with chronic cough.1
The initial investigation begins with collecting a detailed patient history and conducting a physical exam, as well as a chest x-ray.1
As part of the initial investigation, patients should always be screened for potentially life-threatening symptoms, also known as “red flags.”1
The presence of “red flags” may suggest an underlying condition associated with the chronic cough that should first be addressed and evaluated.1
If the initial investigation does not yield a diagnosis or reveal an underlying factor contributing to the cough, patients should next be assessed and appropriately treated for underlying conditions commonly associated with chronic cough, such as gastroesophageal reflux disease, asthma, upper airway cough syndrome, and nonasthmatic eosinophilic bronchitis.1
For some patients with chronic cough, the cough persists after evaluating for underlying conditions.6
Refractory chronic cough, or RCC, is a type of chronic cough that persists despite identification and appropriate treatment for an underlying condition or conditions.6
Unexplained chronic cough, or UCC, is a type of chronic cough where an underlying etiology cannot be identified, despite a thorough diagnostic workup.6
Some patients may experience chronic cough that persists for months or even years.6
Patients may be physically, socially, and psychologically impacted by this chronic condition.2
Thank you for joining me today to gain a better understanding of the clinical assessment of chronic cough in adult patients.
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Irwin RS et al. CHEST. 2018;153:196–209.
Satia I et al. Clin Med. 2016;16 (suppl 6):s92–s97.
Keller JA et al. CHEST. 2017;152:833–841.
Gibson PG. J Allergy Clin Immunol Pract. 2019;7:1724–1729.
Boulet LP et al. CHEST. 2015;147:804–814.
Gibson P et al. CHEST. 2016;149:27–44.
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