Diagnosis and Treatment of Chronic Cough

Comprehensive practical resource for clinicians Clear explanation of assessment and treatment Discussion of novel diagnostic and therapeutic options This book is a practical resource for clinicians who manage patients with chronic cough, which represents a major challenge in the clinic due to multiple diagnostic and therapeutic considerations. Essential assessments for cough and treatable traits are described, covering the upper and lower airways and the gastrointestinal tract, and appropriate treatments are identified according to the different findings and diagnoses. Based on recent mechanistic and clinical advances, the authors also discuss novel diagnostic and therapeutic options, including pharmacological and non-pharmacological approaches to control cough. Particular considerations of importance when dealing with chronic cough in children and the elderly are addressed separately. The book will be an invaluable guide and reference for all practitioners who require up-to-date information on how best to assess, diagnose, and treat patients with chronic cough. Preface Contents 1: Chronic Cough Introduction Impact of Chronic Cough Clinical Approach Based on the Neuroanatomy of Cough Reflex Pathways Summary References 2: How to Assess Cough in the Clinic Introduction History Subjective Effects of Cough Severity Impact Clinical Examination Investigations Routine Investigations Chest Radiograph Spirometry Additional Investigations Thoracic Computed Tomography Bronchoscopy Sinus Imaging and Upper Airway Endoscopy Markers of Eosinophilic Airway Inflammation Gastrointestinal Investigations Cough Frequency Other Investigations Follow-Up Summary References 3: Diagnostic and Therapeutic Trials for Chronic Cough in Adults: An Overview Introduction History Taking Cough Duration and Cough Description Cough Triggers Family History Cough Assessment Cough Questionnaires Cough-Associated Symptoms Other Medical Conditions to Consider Risk Factors Physical Examination and Diagnostic Tests in Assessing Patients with Chronic Cough Physical Examination Blood Samples Chest X-Ray Spirometry with Reversibility Testing Methacholine and Mannitol Provocations Capsaicin Cough Sensitivity FeNO Induced Sputum Chest Computed Tomography Scan (CT) Gastroscopy and 24 h Oesophageal pH Measurement Oesophageal Motility Recording Laryngoscopy Rhinoscopy Therapeutic Trials When Treatable Traits Are Not Found and Risk Factors Are Excluded Corticosteroids and Anti-leukotrienes Neuromodulatory Agents Drugs with Pro-motility Activity Anti-acid Drugs H1-Antihistamines Non-pharmacological Therapy (Cough Control Therapy) Summary References 4: Upper Airways: Assessment and Treatment for Cough Introduction Sinonasal Disease and Chronic Cough Diagnostic Tools Treatment Laryngeal Dysfunction and Chronic Cough Diagnostic Tools Treatment Conclusion References 5: Lower Airways: Assessment and Treatment for Cough Introduction Assessment of Chronic Cough Related with Lower Airways Disease Pulmonary Function Test Induced Sputum Test Fractional Exhaled Nitric Oxide Chest CT Bronchoscopy Treatment of Chronic Cough Related with Lower Diseases Cough Variant Asthma Nonasthmatic Eosinophilic Bronchitis Atopic Cough Summary References 6: Gastrointestinal Tract: Assessment and Treatment of Cough Introduction Prevalence of GERC Mechanisms of GERC Assessment of GERC GERC Treatment Conclusion References 7: Pharmacological Management of Cough Introduction Pharmacological Managements Targeting Eosinophilic Airway Inflammation Cough Neuromodulators Promotility Agents Novel Treatments ATP Story Neurokinin Story ACE Inhibitor Conclusion References 8: Non-pharmacological Control of Cough Non-pharmacological Approaches for Chronic Cough Components of Non-pharmacological Treatment Approaches Evidence for Non-pharmaceutical Approaches Mechanisms for Non-pharmacological Approaches When Should Non-pharmacological Approaches Be Used for Chronic Cough? Non-pharmacological Combination Approaches Conclusion References 9: Chronic Cough in Children Introduction Definition of Chronic Cough in Children Common Causes of Chronic Cough in Children Asthma Protracted Bacterial Bronchitis Nonspecific Cough That Resolves Without Specific Treatment (or Post-infectious Cough) Upper Airway Cough Syndrome Gastroesophageal Reflux Disease Tic Cough (Habit Cough) and Somatic Cough Disorder (Psychogenic Cough) Other Causes of Chronic Cough in Children Clinical Approach (Fig. 9.1) Clinical History and Physical Examination Initial Diagnostic Tests Chest Radiography Pulmonary Function Tests Classification into Specific and Nonspecific Cough Empirical Treatments in Children with Chronic Isolated Cough (Cough Without Any Other Specific Cough Pointer) Additional Diagnostic Tests Chest CT Scan Bronchoscopy Sputum Testing Allergy Testing Esophageal pH or Multichannel Intraluminal Impedance Monitoring Fractional Exhaled Nitric Oxide Treatment of Chronic Cough in Children Summary References 10: Chronic Cough in Older Adults Introduction Epidemiology Clinical Characteristics Therapeutic Considerations Summary References