You’re listening to ReachMD. This medical industry feature, titled “Understanding Chronic Cough and Its Potential Impact on Patients” 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 Doctor Michael Blaiss, Clinical Professor at the Medical College of Georgia at Augusta University in Augusta, Georgia.
And I’m here today to talk to you about a problem that we may encounter in clinical practice, a problem that may impact some adult patients...and that is chronic cough.1
Coughing is a fundamental, protective reflex in response to airway irritation,2,3 but a protective cough reflex can become disordered and lead to a persistent symptom complex.2
For adult patients, coughing can be classified by duration. And when we talk about chronic cough, it’s a cough that lasts greater than 8 weeks in duration.4
Now the typical person with chronic cough is a woman in her 50s. 1
Now, according to an article in a European journal, chronic cough may present as a dry, minimally productive cough, that is associated with an irritating sensation in the throat, and that irresistible urge to cough.1
Some patients may experience frequent, prolonged, and distressing bouts of coughing.1
Patients may report that their cough is triggered by non-tussive stimuli, and these include things like cold air, perfume, voice projection, or exercise. Now this is also known as allotussia.2
Now they may also report excessive coughing to stimuli that are normally cough inducing, and we call this hypertussia.2,5
Chronic cough may affect patients physically, socially, and psychologically.1
Patients report that it can impact their health-related quality of life.1,2
They may experience dizziness and headaches, stress urinary incontinence in women, sleep disturbances, hoarseness, and exhaustion.1,6-8
Socially, they may experience interference with their lifestyles and social gatherings, as well as speech interruptions.6,8
Patients may also experience frustration and embarrassment, fear of underlying illness, and depressive feelings.1,6,8,9
Now to assist clinicians with the evaluation of patients with chronic cough, the American College of Chest Physicians, or CHEST, has provided guidance for assessing patients and evaluating potential underlying factors and conditions.4
The evaluation of chronic cough can be lengthy for some patients.4
According to the CHEST guidelines, this evaluation may involve multiple tests, procedures, and treatment of a potential underlying conditions to investigate potential underlying factors and conditions.4
Chronic cough is commonly associated with an underlying condition, such as gastroesophageal reflux disease, asthma, upper airway cough syndrome, or nonasthmatic eosinophilic bronchitis.4
In some patients with chronic cough, treatment of an underlying condition does not resolve the cough, or an underlying condition cannot be identified.10
Refractory chronic cough, or RCC, is defined as a type of chronic cough that persists despite identification and appropriate treatment for an underlying condition or conditions.10
Unexplained chronic cough, or UCC, is defined as a type of chronic cough where an underlying etiology cannot be identified, despite a very thorough diagnostic workup.10
Thank you for joining me today to gain a better understanding of chronic cough and the potential impact that it may have on your patients.
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- Satia I et al. Clin Med. 2016;16(suppl 6):s92–s97.
- Gibson PG. J Allergy Clin Immunol Pract. 2019;7:1724–1729.
- Keller JA et al. CHEST. 2017;152:833–841.
- Irwin RS et al. CHEST. 2018;153:196–209.
- McGarvey L et al. J Allergy Clin Immunol Pract. 2019;7:1711–1714.
- Kuzniar TJ et al. Mayo Clin Proc. 2007;82:56–60.
- Chronic cough. Mayo Clinic Web site. https://www.mayoclinic.org/diseases-conditions/chronic-cough/symptoms-causes/syc-20351575. Accessed January 7, 2021.
- French CL et al. Arch Intern Med. 1998;158:1657–1661.
- Dicpinigaitis PV et al. CHEST. 2006;130:1839–1843.
- Gibson PG et al. CHEST. 2016;149:27–44.
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