Chronic Cough

 

chronic cough is usually a dry cough that lasts for more than 2 to 3 months. With Laryngopharyngeal reflux (LPR) patients often report a cough for several years.  See also management of chronic cough under 'Respiratory' for common causes and management

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Exclude Red Flag Symptoms

Rule out non ENT sinister features - see management of chronic cough under 'Respiratory' for further details management

In the ENT context:

  • Odynophagia
  • Recent onset dysphagia
  • Persistent constant hoarse voice
  • Weight loss
  • Risk factors:  age, smoker, heavy drinker

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Management

  1. Undertake a chest x-ray to rule out other causes such as Asthma
  2. Conservative management aims to consider causes of irritation such as a dryness (poor hydration or medication) or smoking
    1. A pharyngeal pouch may be present in someone with a chronic cough
  3. The most common cause of chronic cough is LPR although smoking may be a close second
    1. This is due to an aerosol of stomach juices drifting to the naso- oro- and hypo-pharynx. The acid is neutralised and the damage is done by pepsin which is taken up by the epithelial cells. The response is to cause inflammation and increase mucus production. The symptoms include abnormal throat sensation (globus), cough, intermittent hoarseness, postnasal drip and catarrh. Patients often do not have symptoms of GORD
  4. The definitive treatment is Gaviscon Advance 10mls 15 minutes after main meals and before bed
    1. A PPI for 8 weeks is often added in. Improvement can take up to 8 weeks
    2. In difficult cases some people add in domperidone

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Advice and Guidance is being made available for all specialties, and is being provided by consultant specialists at East Kent Hospitals.  To make a request or to check to if a query has been answered, you will need to log in via the electronic Referral System (eRS)

Click here for the "how to access" e-Referral Advice and Guidance Manual for instructions on how to make a request and check responses

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