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* Etiology
* Patient Profiles
* Resources
* Search

ADVANCING SCIENCE IS BROADENING OUR UNDERSTANDING OF THE POTENTIAL MECHANISMS OF

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Both animal and human studies support the science used to illustrate pathways in
this figure. Clinical significance of animal data is unknown.1,4

SEE CHRONIC COUGH POTENTIAL MECHANISMS OF DISEASE IN ACTION

These potential mechanisms differ from the protective-cough reflex, which is
important for clearing the airways of inhaled particles.1,5,7

Cough hypersensitivity is a common characteristic in patients with chronic
cough2,8

identify COUGH hypersensitivity

Learn more about evolving scientific research on potential mechanisms of chronic
cough2

watch the VIDEO now

Both mechanical and chemical stimuli within the airways can evoke coughing.1

—Mazzone et al, Physiological Reviews, 2016

The 2017 American College of Chest Physicians (CHEST) Expert Panel published
updated clinical guidelines THAT INCLUDE INFORMATION for THE management OF
chronic cough9

The guidelines recommend following the steps summarized below:

Conduct an initial investigation of patients with chronic cough (>8 weeks) to
assess patient history, which includes any red flags (shown below), occupational
and environmental issues, travel exposures, physical exam, and chest radiograph.
Always consider smoking history, medications known to cause cough, and whether
the cause of cough suggests a life-threatening condition.9

In patients whose initial assessment does not reveal factors that may contribute
to cough, further investigation into common underlying conditions (eg, asthma,
GERD, UACS [postnasal drip], NAEB) is needed.9

* Other investigations may be considered including swallow evaluations, sinus
imaging, cardiac workup, and occupation assessments9

GERD, gastroesophageal reflux disease; UACS, upper airway cough syndrome; NAEB,
nonasthmatic eosinophilic bronchitis.

If cough persists despite appropriate investigation and treatment for each
diagnosis or suspected diagnosis, consider referral to a cough clinic for
investigation of refractory chronic cough or unexplained chronic cough.9

What are potential red flags when assessing patients presenting with chronic
cough?

Red flags include9:

* Hemoptysis
* Smoker >45 years with a new cough, change in cough, or coexisting voice
disturbance
* Aged 55-80 years: 30 pack-year smoking history, and current smoker or quit
<15 years ago
* Prominent dyspnea, especially at rest or at night
* Hoarseness

* Systemic symptoms, including fever, weight loss, and/or peripheral edema with
weight gain
* Trouble swallowing when eating or drinking
* Vomiting
* Recurrent pneumonia
* Abnormal respiratory exam and/or abnormal chest radiograph coinciding with
duration of cough

Important reminders9:

Check for red flags (shown above) and address them

* Optimize therapy for each diagnosis
* Check compliance during regularly scheduled and frequent follow-ups (assess
for patient barriers to enactment or receipt of instructions)
* Due to the possibility of multiple causes, maintain all partialIy effective
treatment

* Routinely assess for environmental and occupational factors
* Routinely assess cough severity and HRQoL with validated tools
* Routinely follow up with patient in 4-6 weeks
* Consider a referral to a cough clinic for refractory cough

References: 1. Mazzone SB, Undem BJ. Physiol Rev. 2016;96:975-1024. 2. Mazzone
SB et al. Lancet Respir Med. 2018;6:636-646. 3. Bonvini SJ, Belvisi MG. Pulm
Pharmacol Ther. 2017;47:21-28. 4. West PW et al. Am J Respir Crit Care Med.
2015;192:30-39. 5. Smith JA, Badri H. J Allergy Clin Immunol Pract.
2019;7:1731-1738. 6. Canning BJ et al. Chest. 2014;146:1633-1648. 7. Canning BJ.
Pulm Pharmacol Ther. 2011;24:295-299. 8. Roe NA et al. Curr Otorhinolaryngol
Rep. 2019;7:116-128. 9. Irwin RS et al. Chest. 2018;153:196-209.

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Red flags include1:

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