start at 34:00
All that follows is from the above resource.
“AHEM, AHEM”! A RATIONAL APPROACH TO COUGH WITH DR. BRAD HAYWARD
Listen as our phenomenal guest Dr. Brad Hayward @bradleyjhayward (Weill Cornell Medicine) demystifies chronic cough for the primary care provider. Dr. Hayward, an internist, pulmonologist, intensivist AND palliative care physician sits down with us to discuss common causes for chronic cough, work up pearls and options for treatment. Follow him on Twitter, @BradleyJHayward.
- Subacute/chronic cough is one of the most common primary care complaints seen by providers
- The most common cause for acute (and subacute cough) is active or recent viral infection (“post-viral cough syndrome”) for which a trial of inhaled corticosteroid is reasonable
- Other common causes for cough include gastroesophageal reflux disease, post-nasal drip / upper-airway cough syndrome, cough-variant asthma and non-asthmatic eosinophilic bronchitis
- The first step in evaluating cough should not be labs and imaging, but rather a thorough history focusing on things like onset, aggravating/alleviating factors, quality of the cough and exposure history
- Chest X-ray can be useful to identify major anatomic abnormalities, CT can be used later on if cough persists to rule out more subtle disease states
- Basic spirometry can be helpful to identify obstruction early on in a patient’s course – save full pulmonary function testing for later
- Don’t be afraid to try empiric therapies! Proton pump inhibitors, antihistamines, intranasal steroids and even inhaled corticosteroids are generally low-risk and will treat many cases of chronic cough
- Feel empowered to refer these patients to pulmonary… but also feel empowered to try the aforementioned therapies and start an initial work up