Today, I review, link to, and embed ACCP Chest’s “Refractory Chronic Cough: A Primary Care Primer”.
All that follows is from the above resource.
title
Apr 8, 2026Transcript
Hello, I’m Anjie Peters. I’m an allergist from Northwestern University in Chicago, Illinois. And it is my
pleasure today to join Dr. Michael Blae and Dr. Michael Gabriel. And I’ll let
them introduce themselves in a second. We’ll be presenting on refractory chronic cough, a primary care primer.
Michael Gabrielle. It’s Michael Gorriel. I’m um pulmonologist at Cleveland Clinic and I
lead the program for chronic cough over there. Pleasure to be with you
Michael. Yes. Um so I’m Dr. Michael Blae. I’m a clinical professor at the Medical
College of Georgia at Augusta University in Augusta, Georgia. And I’m happy to be here uh for this uh webinar.
Thank you very much for joining me today. Next slide.
So the objectives today are to review the underlying drivers and mechanisms of
cough, describe evolving terminology and clinical characteristics of cough,
chronic cough and refractory chronic cough or RCC. understand the impact of RCC across
health, quality of life, social and economic domains and outline how to
perform a thorough cough assessment, diagnostic workups, and the next steps
in primary care in patients with chronic cough. We’ll determine when a patient
with suspected RCC should be referred to a specialist.
Next slide. So when we think of chronic cough and it
is one of the most common reasons a patient comes to a primary care physician. Next slide.
So why do we cough? In most of us cough is a protective reflex in response to
some kind of irritant. It could be a pathogen. It could be mucosal. Um it
could be it could be mucus or an environmental irritant. The goal is to clear the airways and the lungs.
Occasionally, cough is normal, but cough that persists beyond 8 weeks should be
evaluated by a health care provider.
Next slide. So, when we have when we cough, there are typically three phases of the cough. First is the inhalation,
which generates enough volume in our lungs for effective cough. Two is the compression with pressure against the
closed larynx or glatus where the chest wall, the diaphragm and the abdominal muscles contract. And finally the
expiration phase which begins when the glatus opens and results in the high air flow resulting in the cough. Next slide.
So in terms of pathogenesis of cough it involves the neurespiratory pathways involving both the peripheral nervous
system and the central nervous system. In the peripheral nervous system the
signal is initiated by aerant nerves to stimuli that could be in the ear and
fairings larynx our lungs our heart or esophagus. These signals then go into
the brain stem or the central nervous system then translates and modulates the
signal that then results in motor neurons transmitting the cough to the respiratory muscles. Next slide.
So moving on to cough and primary care. Cough is one of the top reasons for
primary care visits and primary care providers. The PCPs are usually the first health care provider to see a
patient with cough. PCPs are well positioned to perform the
initial cough workup and are more accessible than specialists. And PCPs can administer some of the trial
treatments in the initial diagnosis and management of cough.
In terms for adult patients complaining of cough, the best way to think about it and these are chest recommendations for
definition of cough in adults. Acute cough is when cough is present for up to 3 weeks. Subaccute is between 3 and 8
weeks and we’ll focus mostly on chronic cough which is cough present for more than 8 weeks. The duration of the cough
is our first step in narrowing the list of potential diagnosis. And you know we
should use evidence-based guidelines and we’ll discuss one of the evidence-based guidelines that is here in the US which
is the chest guidelines.
When we think of classification and non-lifethreatening ideologies of cough, you always want to screen for presence
of red flags. In acute cough, which is cough for up to three weeks, typically
it’s exacerbation of some kind of pre-existing condition. For example, an upper respiratory tract infection, a
lower respiratory tract infection, especially in someone like who has asthma and then would cough for up to 3
weeks as they recover. Subaccute cough or cough between 3 and 8 weeks also
often is an exacerbation of an underlying disease. usually things like COPD, asthma, and then sometimes
post-infectious causes and sometimes even something serious like TB and then
chronic cough more than 8 weeks. Think of things that are common. ACE
inhibitor, make sure they’re off of that. However, chronic cough can also be from common conditions that are
associated with cough. asthma, upper airway cough syndrome for some sinasal
reason, non asthmatic eosinophilic bronchitis and even gird. And that’s how
I would think of coughs. Next slide.
So moving on to our next speaker.
Thank you, Anja. And what we’re going to do now is move further and talk about about chronic cough. Uh and as we’ve
heard cough obviously is an extremely common problem uh that is seen by by all
clinicians and specifically we’ll be talking about chronic cough which in of
itself is in fact as we’ll talk about very common. In fact, the survey uh from
the United States by Meltzer at all suggested that about 5% of the US population in fact surveyed had chronic
cough. And I’ll mention that in fact other surveys out there have suggested
the number may be as high as 10% of the population. What we do know about
chronic cough is the prevalence that it does increase with age. uh not
surprisingly we see this higher uh in patients people that in fact have a
history of smoking and in fact also may be higher in women. Next slide.
Very importantly we need to understand the health care cost that are associated in these patients in fact that are
suffering uh with chronic cough. So not surprisingly they incur much higher
health care cost and use much more health care resources than what we see in the typical patient having acute
cough problems. These patients have been shown to have more contacts uh with
health care uh professionals including generalist and specialist and obviously
a high amount of prescription in fact over-the-counter treatments for their particular condition.
Very importantly, we see that in fact they tend to have repeated diagnostic test uh and their long journey to try to
determine exactly what in fact is causing their chronic cough. So it’s not uncommon for these patients to have had
a great deal of imaging especially again related to the chest uh spometry and
allergy testing. uh and unfortunately again during these patients journey to
diagnosis unfortunately many times they get the same test over and over again.
We also these patients in fact get many referrals and have multiple specialty
evaluations that are trying to determine the cause of their particular chronic
cough problem. In fact, data has suggested that almost 80% of these
patients see two or more different specialists or go to different medical facilities uh before in fact a diagnosis
is established for this condition. And these patients tend to go through numerous trials of treatment with
multiple agents. And again, many times the same agent several times because
unfortunately the treatments we have available in fact are not that effective at this time for chronic cough. In fact,
there are no FDA approved products for chronic cough at this time. Next slide.
Um so let’s look at this slide looking at utilization of medical services by
patients with and without chronic cough in the past six months. This was a study by Meltzer at all that was published in
Jackie and practice in 2021. This data came from the 2018 National Health and
Wellness Survey. Um this is data on almost 75,000 Americans and they match
what we see in the total US population. In this study uh we have uh the orange
group or patients uh without chronic cough. Uh the blue group is the patients
with chronic cough and what you can clearly see here is the much higher rate
of hospitalization, emergency department visits and health care visits uh to
physicians uh in the patients with chronic cough. This is over a year basis
compared to the group without chronic cough. Next slide.
So here we’re going to look at the impact o of chronic cough on the patient
a and as we go through these many of these in fact are associated with a condition we’ll be talking about shortly
and that is those patients that are suffering with refractory chronic cough. So if we just look clinical many of
these patients have these severe cough spasms uh that can last for a long
period of time may cough up to a 100 times an hour. So things like dizziness
and headache, it’s not uncommon to have sleep disruption related to chronic cough. And again, because of the severe
coughing burst, they can just have significant exhaustion associated with the problem. Very common in the female
population, we see stress urinary incontinence. And I’ll mention that most of the time patients won’t volunteer
this. you really have to ask if in fact the patient is having any problems with
urinary incontinence associated with their coughing. Uh if we look at social
uh many of these patients just talking in fact and we see this with refractory chronic cough u in fact will go into a
severe cough spasm. Uh they have avoidance of activities. They never know when they’re going to have a severe
cough episode. So they don’t want to go to the theater, don’t want to go to the movies, don’t want to go to places uh
with their family, friends, co-workers, and again the amount of disruption that this causes in their life. And so not
surprising that they have a great deal of psychological problems associated with chronic cough. So we see a much
higher rate of depression, anxiety than what we see in the general population. These patients are very self-conscious
and embarrassed by their condition. So again, they tend to isolate and and stay
away from from individuals. And also we have to understand and be empathetic with these patients. They’re concerned
about having a serious underlying disease. They’ve been to to many other uh physicians uh and other health care
providers and no one can find the cause of their problem. So they’re concerned they must have a malignancy or some
other type of problem uh that uh that no one in fact can find. And then we can
look at economic uh again with the sleep disturbance. They’re going to have fatigue during the day. They’re going to
have impaired productivity or what we call presentism. And as mentioned in the in the Meltzer
study, we have more emergency department visits and hospitalizations. Next slide.
So again, this comes from from the Meltzer study and again we’re looking at
uh in the blue the patients with chronic cough and in the orange the patients without chronic cough. And if we look
over uh on the left we’re looking at the use of the SF36 which is a generic
quality of life instrument. So it’s a type of instrument can be used for all types of disease states and conditions.
It’s divided in both the metal comp mental component score and the physical
component score. The higher the score, the better the quality of life. And what you can see here, the quality of life in
both the mental score and the physical score is significantly better in the group uh that does not have chronic
cough compared to the group that has chronic cough. And in fact, if you look at the minimal clinical important
difference, in fact, what the patient uh notices, again, it it’s significant that
these patients in fact have a poorer quality of life. And if we look over on the right, we’re looking at work
productivity impairment, looking at percent hours uh over a week period of
time. And again when we look at work productivity in the blue here the
patients with chronic cough it is much higher than what we see in the group without chronic cough. Next slide.
So how do I perform a thorough cough evaluation? So let’s go over that on the
next slide. So what do we need to include uh when
we’re doing that thorough cough assessment on that patient? So one and
very importantly uh we need to have a review of all their prior evaluations. Again it’s not uncommon these patients
have seen many other uh physicians have been to many other health facilities uh
for this problem. uh along with that we need to see in fact all the other tests
that in fact have been done on the patient so we don’t keep repeating the same test over and over. We need to know
all the medications that they’ve tried for their cough and what in fact has happened. We also need to know all
medications they’re taking because as we know things like ACE inhibitors can lead to chronic cough. We need to know the
duration of the cough. You know is it definitely chronic cough. have been going gone later greater than 8 weeks.
We need to know what in fact led to the onset of the cough that may be helpful
in coming to a diagnosis. What is the severity of cough and the impact on the patient? We may want to use certain
types of questionnaires or a visual analog scale to determine the severity of the patient’s problem. The location
of the cough. Does a patient feel it more in the chest or in the throat or in the upper airway and in the sinuses and
the nose seem to be triggering the problem? And those hints can be very helpful. What are the features of
characteristics of the cough? Is it a wet cough? Is it a dry cough? And what in fact is the patient coughing up if
they are? And then what possible triggers uh occupational or or in the
home uh environmental types of things that may in fact be leading uh to
triggering the patient’s cough or is it just eating or drinking in fact or
talking or laughing in fact triggering the cough. Next slide.
So that leads us then on how do I work up a patient with in fact chronic cough.
And here we’re going to be looking at on the next slide um is this paper. Uh
Peter Descenditis was the first author. I was one of the authors that looked at a diagnostic algorithm for cough and
primary care. And obviously the first thing we do in all of our patients and it’s very paramount in these patients is
a history and physical exam. So some of the things I mentioned things like cough
duration, triggers, presence of other symptoms. Obviously we need to look for for causes as we go through that history
and physical exam. So infectious causes again talking about medication like ACE
inhibitors. Is there any social occupation environmental exposures that may be triggering cough and again very
importantly is a complete physical exam of these patients and not just the chest. Uh but obviously all these
patients uh must have chest x-rays. They must have spometry. And then we also
want to find out how in fact is the cough affecting the patient both physically, socially and emotionally on
their quality of life. And then that leads us and we’ll go to the next slide.
Um if we do not find anything there, these in fact uh as mentioned uh by Anja
before are the most common causes of chronic cough in the population. And
first we have upper airway cough syndrome and that includes the patients that are having chronic sinus problems,
allergic and non-allergic rhinitis problems. So in the history many times we get a history of the cough again with
or without rhinora or nasal stuffiness, sneezing, post-nasal drip. And what we
usually try to begin with as far as empiric treatment to see if this will control the cough is in fact something
that we don’t use that often and that is a first generation antihistamine. And
the reason we use that over the typical second generation antihistamines that we use for allergic rhinitis and other
conditions is because of its anticolinergic effect to help dry up any post-nasal drip. Now if the cough
resolves then in fact we have a diagnosis here that we have upper airway cough syndrome. If the cough persists
again it may be related still to upper airway cough syndrome we may want to try a course of topical nasal cortical
steroids. If the patient still doesn’t respond then in fact referral to an
allergist or an autotoarangologist may be indicated. If we look at the next slide, we’ll conone into the the
pulmonary conditions we need to look at and that being asthma and non-asthmatic
eosinophilic bronchitis. Now non-asthmatic eosinaphilic bronchitis is a chronic lung condition um high
eosinaphils in the lungs but unlike asthma there’s no evidence of airway hyper reactivity.
So these are patients that are coughing with or without shortness of breath, uh wheezing, chest tightness and very
importantly here is spometry pre and post bronco dilator uh to help determine
if in fact it is asthma or non-asthmatic einaphil bronchitis. If in fact we do
see improvement with bronodilator that suggest a diagnosis of asthma and to try
and inhale cortical steroid. If there is no improvement and we believe it’s a pulmonary condition, we would still
treat with an inhaled cortical steroid because that would be very beneficial in patients with non asthmatic eosinaphilic
bronchitis. If the patient’s not getting better after a trial of inhaled steroids, then referral to a
pulmonologist or allergist would be indicated. And the third condition here
on the next slide, we’re talking about gastroosophageal reflux disease. So is
there a relationship in the patient’s chronic cough with heartburn or a globus
sensation or regurgeness going on? Uh and then if again we get
that history, we want to do diet and behavior uh modifications. So removing
certain foods, spicy foods, foods with caffeine, um having patients not eat
three hours before they go to bed. Um raising the head of the bed. Again,
different things we do to help control GIRD. And then a trial of proton pump inhibitors, usually at twice the
recommended dose. If the cough resolves, then we have again compatible with GIRD
as far as the cause of their problem. If the cough continues, we may want to try
proinetic therapy. We may want to refer for a GI for further evaluation of GER.
So if we go to the next slide,
uh here’s some of the assessment again to look at uh in primary care. So
[snorts] again the history, the age again um these patients tend to be older
uh are they smokers? Occupational exposures again cough assessment medications again the main one being ACE
inhibitors. Uh insaids are on here because in patients with asthma some
have aspirin exact respiratory disease and giving them an insaid would worsen their condition and therefore the cough.
And again opioids in high doses uh can lead to release of histamine which in
fact could lead to uh upper airway cough syndrome uh and prostenoid eye drops.
But the major one here to think about always in the history is ACE inhibitors. Also one needs to think about non-
selective beta blockers. They could induce cough especially in that patient with possible underlying asthma. Of
course, we want a comprehensive physical exam. Uh chest X-ray. Uh as we
mentioned, uh again, I typically use a visual analog scale in the office
situation, having the patients rate from 0 to 100. Um zero being no cough, 100
being severe cough they can’t tolerate and follow the patients that way on severity. But there are validated
instruments like the Lester cough questionnaire which look at quality of life and symptomatology. And then very
important are red flags. So these are conditions that one should pick up in the history and in your physical exam uh
that could be serious causes of chronic cough in the patient. And if we look at the next slide, we in fact see here,
next slide, we see a list here in fact of red flags
that we need to be looking at. Um so things like hopsis in the patient, a
smoker with a new cough, a smoker with a long pack history um of coughing.
Obviously we get concerned about malignancies there. uh prominent disme especially at rest or at night. We may
be dealing with congestive heart failure. Uh horarsseness as we mentioned systemic symptoms, fever, weight loss
could be an underlying malignancy, difficulty swallowing uh when eating or drinking that could be an esophageal
malignancy. It could be a neurogenic problem that’s going on the patient, vomiting, recurrent pneumonia, an
abnormal respiratory exam, abnormal chest X-ray that in fact responds with the duration of cough. So again, we need
to be thinking about these things as we go through the history and physical exam. Next slide.
So I’m going to turn over the discussion uh to Mike here on refractory chronic
cough. Thank you Michael. Thank you Andrew. Um in this next section we will be talking about a condition trying to
dive in deeper into just a subset of chronic cough that we label it as
refractory chronic cough. Tell us what are the next steps when patient has a refractory chronic cough. Next slide
please. We will talk about what do primary care providers need to know and what do they need to do when a patient
presents with a refractory chronic cough. What is refractory chronic cough? How can we define it? How can we
standardize the language that we all talk so patients do not get confused?
How does refractory chronic cough impact patients life? What is neuronal hypersensitivity? how it contributes to
the development of refractory chronic cough and how can we recognize refractory chronic cough and address
patients concern accordingly. Next slide please. So refractory chronic cough as um Anvin
Michael has mentioned is a a disease in its subset of patients with chronic coughs that lasts more than 8 weeks and
it persists despite guidelines directed therapy thorough evaluation and adequate
empiric treatment trial for most common conditions contribution to development
of chronic cough as mentioned before asthma noner noninhilic non-asmatic
einhilic bronchitis acid reflux and upper airway cough syndrome. It’s typically more common in women than men
with instance and prevalence of more than 2/3 in women and it typically tends
to occur in patients in the fifth and sixth decade in life. Next slide please.
Okay. One of the main causes for patients confusion and dissatisfaction is the the lack of stand.
You talk to 700 more than 700 healthcare providers that’s that were surveyed and
we got more than 15 different terminologists trying to describe the
same exact uh phenomenon trying to describe how these patients in different language. Idiopathic chronic cough,
persistent chronic cough, refractory chronic cough, unexplained chronic cough, neurogenic, neuropathic, neuronal, lenial hypersensitivity, you
name it. It’s a habitual cough, it’s sensory cough. So so many different terminologies and as if we do patients a
favor when they come to to to a different provider or a different specialist and we label them with a
different label that pretty much describe the same thing that they have heard from the previous uh provider that
they have seen and this really leaves patients with with confusion and and and mistrust on do we even know what we are
talking about? or we trying to diagnose something that no one can can diagnose and basically no one can treat. Next
slide please. So in in in order to to understand how
these patients are coming from, these patients have been seen by different
specialties from allergy, from GI, primary care, ENT and they have had they
have been waiting for typically several weeks or months before they have seen a
a specialist or seen a provider who can address this refractory chronic cough. um some um very common they they have
been waiting for years until they have been seen and appropriately evaluated
and and triaged for this condition. All through this time they have been suffering from physical, social and
psychological um impacts on their on their overall quality of life. They have endured a lot of workup, repeated
testing, um questionnaires and they they they really lack the the the feeling
that they have been um heard and their symptoms have been validated and adequately addressed. using using um
appropriate guidelines most commonly we refer to chest guidelines and the ERS guidelines can help uh u narrow the
diagnosis shorten the duration until these patients have been appropriately diagnosed and it’s important to always
remember that refractory chronic cough is a diagnosis exclusion there is no current test or or questionnaire that
you can provide to these patients and you can you can tell them for sure you have a refractory chronic cough next
slide is in a recent survey that has been uh
conducted among patients with refractory chronic cough about quarter of them are
feeling uh depressed and anxious. So the taking away the confusion for um the
lack of terminology or standard terminology about their diagnosis they also feel depressed and anxious. More
than twothirds um have of women have reported symptoms of urinary incontinence. Not just that it’s um very
frustrating to their uh quality of life but also they they come and tell you our
surgeon cannot treat us before we get this cough under control. People can develop hernas and they would not get
treatment before this cough has been taken care of and controlled and about 18% of postcoid patients have developed
uh or have reported refractory chronic cough. In a more recent multic-enter uh non-intervention cohort study in Spain
in patients with refractory chronic coughs that has been lasting more than one year almost 60% have reported that
their cough has significant quite a bit much very much impact on their quality
of life. So we are talking about the symptom that’s really impacting and affecting patients quality of life to a
great extent. Next slide please.
So what are the clinical characteristics that patients with refractory chronic cough will report to you when you see
them in in in your practice as a primary care physician? Typically this uh cough would be mostly dry or minimally
productive of mucus has been uh lasting for more than 8 weeks but in in in in fact it’s if if you ask patients as
Michael Blaste have told us uh taking a good history they would tell you they
have been coughing for months or probably years and they are very unique in how they describe their symptoms.
They tell you we cough in fits or bouts of u
several seconds or can last actually for minutes. Some of some of these cough bouts can be associated with vomiting
can be associated with syncopy and really um we have all seen patients who
have been in car accidents because they developed a coughing fit while they were driving and and they passed out. And
cough hyper sensitivity has been observed in um these patients upon
exposure to different triggers. Some patients would tell you I get exposed to perfumes or certain candle scents or
certain others. If I’m if I’m laughing or if I’m talking, if I’m singing, if
I’m getting in the car and the uh air condition vent are directed to me or if I’m walking out and it’s cold outside, I
start having one of these coughing fits. and they would refer to to to their throat. Often times they tell you it
starts as a as a tickle in my throat or it’s an urge to cough. And this by itself can direct you to the to to
suspect that there may be some neuronal hypersensitivity component to their cough. Next slide please.
So what is neuronal hypersensitivity? It’s important as Andrew has mentioned earlier in the path pathophysiology and
pathway for chronic cough. We have two distinct um areas in our body that
regulate cough. This the peripheral nervous system and also the central nervous system. And the the easiest way
to understand this is that you have disregulation in these two systems where the peripheral nervous system is hyper
excited and the central nervous system is lacking the inhibitory impulses that
suppress cough in this patient population. So increased prefer neurons and changes in the cerebral cortex
result in abnormal state of increased hyper respponsiveness within the central nervous system to this patient to this
patient’s stimuli that um triggers them to cough and there has been recent studies that show that uh in these
patients with refractory chronic cough MRI studies have shown complex network of cortical and subcortical uh changes
in the brain region in the brain regions associated with the development um and
persistence of chronic cough. Next slide please.
What are the symptoms that you would be looking for and what you would be hearing from patients reporting chronic
cough? One of them is fellowsia which is a cough triggered by non-tussive stimuli that normally would not cause cough.
patients telling you talking, laughing, taking a deep breath, perfumes, even while eating certain type of food, nuts,
uh or cold um drinks would trigger me to cough. That’s what we call alotasia. Coughing from something that should not
make them cough. Hypertia is exaggerated cough response to stimuli that normally
would cause just mild or infrequent cough. So for example, people would tell you I get exposed to fog or smoke or um
nebulized irritants or strong response to capsain and my cough would be just like on fire. I I would be coughing for
minutes afterwards. Another symptom is lenial parthesia which is abnormal sensation in the in the throat that
precedes or provoke cough reflecting sensory nerve hyperexitability. people
would refer to you as I feel like something is always constantly itching in my throat, sand, feather, dry patch
or tickling in my throat. There is burning or tingling sensation in my throat. Uh people can report this as
just throat clearing uh compulsion. They are repetitive and frequent urge to clear their their throat. Urge to cough
is a strong premonetary sensation that a cough is about to occur and it’s not fully suppressed. often described as a
rising internal pressure or irritation. And patients will not really read the textbook with it, but they would come to
you and it it would be almost clear that they have something in their throat
that’s triggering them or provoking them to cough. And there are stimuli that typically should not be making them
cough or should not make them have significant cough, but they really lack the the control and the inhibitory
impulses on controlling this cough. Next slide, please.
Thank you very much, Michael Gabrielle. Thank you, Michael Blae. So, let’s move
on to what is the PCP’s role in patients with confirmed or suspected refractory
chronic cough. Next slide. So the key roles of the PCP in diagnosis
and management of chronic cough really the exact role depends on patients needs
and access to the specialists. It is important to note that chronic cough is
a very common condition seen in a primary care setting. So it’s important to ask about cough at each visit in
someone who has complained of cough especially. refer to the chest guidelines. Those are
our US guidelines for guidance and assessment procedures and treatment trials. There are many new treatments
that are being studied for chronic cough. Understand the workup that’s appropriate
at the level of primary care particularly for the common causes that are associated with chronic cough and
even refractory chronic cough such as the upper airway cough syndrome. So looking at sinasal causes, asthma
and gird and then importantly it’s really important to recognize when to refer the
patient to a chronic cough specialist. It’s good to have a rapport with specialists that support you know you
need this is a multidisciplinary team issue. use updated ICD10 code for chronic cough
which is RO5.3 which became effective on October 1st 2021. I think using these ICD10 codes
for chronic cough for both RCC and UCC will help advance the field
significantly. Next slide.
So what’s next when a diagnosis of RCC is made? You know again refer to the
chest guidelines. What we do have are treatment options that can treat the neuronal pathways
including neurom modulators that we may use such as tricyclic anti-dopressants.
Lowdos opioids have shown benefit in refractory chronic cough. Of course we
are limited by the side effects. Speech therapy, speech and language
evaluation is important because that has shown benefit and of course is very well
tolerated. Know when to refer to a specialist, a pulmonologist, an otoarangologist
and an allergist and even sometimes a GI and consider refer referring to a center
which has a chronic cough center where specialists work together in a multidisciplinary team for treatment of
these patients. It is important to note that our currently no medications have
been approved by FDA to re treat RCC. These are used off label. There are
currently clinical trials, early stage trials for opioid analesics. The mixed
agonist antagonist, even your kindin receptor antagonist, etc. The P2X3
receptor antagonist are not FDA approved in the US but are approved elsewhere.
Most importantly, I think for a PCP is to recognize RCC and consider referral
if needed. Next slide. So RCC in primary care key takeaways.
Chronic cough is cough that lasts greater than 8 weeks. It is associated
with many different ideologies. Consider treating the treatable conditions. And then refractory chronic
cough or RCC is a subset of chronic cough. It is a disease not a symptom as
many of us think of it currently. It lasts 8 weeks or longer despite treating
common underlying conditions and utilizing guideline directed care.
Consider referral to a specialist to confirm the diagnosis. It is currently a
diagnosis of exclusion. A primary care role is to perform a thorough history of
cough, identify and treat the common underlying causes, and then again refer to a specialist when coughs greater than
at 8 weeks despite appropriate treatment. You could consider referring
to a cough clinic or a specialist who treats patients with chronic cough. Next
slide. I think this is the end. These are the
references. On behalf of both Dr. Michael Blaze and Dr. Michael Gabriel,
I’m Anju Peters and we really appreciate you joining us today. Thank you.
