Chronic Cough Explained Clearly by | 1 of 2

By Adem Lewis / in , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , /

okay welcome to another MedCram
lecture we’re going to talk about chronic cough now this is something that
is defined as anybody who has at least eight weeks of a cough the first thing
you want to do if this is going on is generally speaking you want to get a
chest x-ray and rule out infectious etiology this is a big problem if you
got an infectious etiology you’re thinking about things like tuberculosis
you’re thinking about pneumonia this is stuff that you ought to have the
physician do right off the bat to rule that out so but let’s just say you’ve
got a normal chest x-ray and then the other thing you want to rule out is to
make sure you’re not on something called an ACE inhibitor that’s a medication
that usually ends in April like captopril lisinopril enalopril
ramipril these ACE inhibitors can cause coffee i increasing bradykinin and so
really if if somebody’s got a chronic cough that you’re trying to work out on
a test the first thing you want to do is make sure you’ve got a chest x-ray to
rule out infectious problem and then look at their med list to make sure
they’re not an ACE inhibitor I would say about 30% of patients with an ACE
inhibitor are going to have some sort of a chronic dry cough okay so once you’ve
ruled these out what are the possibilities let’s talk about what
those possibilities are so there are three possibilities that I like to look
at in terms of chronic cough and the first thing I’d like to do is start off
with one from the top if you will so if you know you’ve got here’s my little
picture here of a of a head the nose the mouth okay you know that the nasal
passageway goes down this way and you’ve got your tongue if you’ve got allergic
rhinitis in this area you’re going to make a lot of secretions and those
secretions are going to pool and then tickle down into the
back of the throat and it’s going to cause you to clear your throat and
that’s what we call post nasal drip or allergic rhinitis okay post nasal drip
allergic rhinitis so what are the symptoms of that clearing your throat a lot okay
if you look in the back of the throat you see this thing called cobblestone
in’ you’ve got itchy eyes or allergies itchy eyes okay so think about all those
things in terms of post nasal drip or allergic rhinitis and I would say out of
out of all the people who have a chronic cough or what we’ve eliminated this
accounts for about 9% of that so think about that the next time someone comes
in with a chronic cough it’s quite possible that we could be dealing with
someone with post nasal drip so what’s the treatment for that well you want to
try to identify the things that’s calling the app that’s causing the
allergies but the treatment generally speaking is intra nasal steroids okay so
you’ve heard of things like Nasonex you’ve heard of flonase you’ve heard of
a stolen or asked to pro as these are all kind of intranasal steroids or
antihistamines okay the other thing that’s indicated for allergic rhinitis
is singulair so that might be something else that you could use for a possible
chronic cough and so if that’s if those symptoms fit that’s great okay let’s go
on to the next possibility the next possibility is also around 9% and then
instead of coming from the top down it comes from the bottom up so here you’ve
got your airway but right next to your airway in fact right behind your airway
is your esophagus which goes down to your stomach
and if you’ve got stuff in there and you get something called gastro esophageal
reflux disease it can sometimes come in and irritate that airway and cause what
we call GERD okay so where do we see GERD occurring GERD is occurring when or
GERD related cough can happen actually in young people you don’t have to be old
typically what you see is an acid taste in the morning let’s lighten that up
here so you can see it a bit better so an acid taste in the morning you
obviously have the symptoms of gastroesophageal reflux disease that’s
heartburn sometimes you might have erosions from the acid in the back of
your throat or specifically in your teeth you might have erythema there if
someone were to look down into your throat like it ear nose and throat
physician they’d see that IV erythema test so what is the treatment for that
so you can use a proton pump inhibitor you can actually get that over-the
counter called prilosec or you can get protonix Pinto Brasil there’s so many
different types of proton pump inhibitors but there’s some other things
that you can do you can take the head of your bed and put it on two bricks so
that it’s facing up alternatively you could also get a wedge the purpose of
this is to keep the head of your bed up so that the abdominal contents don’t
come up and bathe the trachea they stay down but other things that you can do is
no eating three hours before lying down and then there’s this sphincter which is
right here at the stomach and there are a few things that we know about that can
cause that sphincter to open up and you want to avoid those things so those
things that we would avoid especially at night would be alcohol caffeine spicy foods and chocolate okay
so if that seems to be what seems to be fitting and they’re good then these are
the kind of things that you might want to make sure that you’re not doing the
last one is probably the most common this is about 39% so this is probably
the majority and that’s asthma okay so they don’t wheeze they just COFF or
maybe they do wheeze but they don’t have to but just coughing could be a symptom
of asthma and that alone might do it and so what are these type of patients
they’re going to have the symptoms of asthma except instead of wheezing they
go to coughs oh there’s going to be triggers maybe they’ve got down feather
pillows or down feather comforters so look for triggers like down or pets in
the bedroom or allergies you’re not going to really know that this is what’s
going on unless you do a pulmonary function test now look at the med cram
lectures on pulmonary function test to get some idea what asthma should look
like and then the other thing the most diagnostic thing that you will do is a
methacholine challenge test and this is where they take in a breath and do it
fev1 maneuver and then you give a methacholine and you see how they do if
they drop down then you know that they are susceptible to methacholine which
means they’re asthmatic and then you give them an albuterol treatment and
they come back up again if that happens then you know the methacholine challenge
test was positive then it’s asthma you’re talking about and in that that’s
the case then you’re going to use intra or inhaled intra bronchial or inhaled steroids that’s exactly how you treat
asthma here’s the trick though most of the time
this chronic cough is not due to just one of these it’s actually due to
multiple and you’ll see that there’s overlap between these different areas so
you might have to employ different treatments in all of these different
places so think about that the next time you have a patient with chronic cough
think about cough variant asthma which is this one
think about gastroesophageal reflux disease which is this one and think
about allergic rhinitis which is that one thanks very much you

49 thoughts on “Chronic Cough Explained Clearly by | 1 of 2

  1. Very straightforward, thank you! I would really appreciate more videos like this where presentations are covered e.g. chest pain, shortness of breath, epistaxis, etc!

  2. 100,000's of people were cured of TB in the 20's with heliotherapy. my wife use to have a chronic cough year after year. it was so bad that she ended up in the hospital. they said its a super bug here is some drugs please leave the hospital. took me a few days to figure her problem out and now she does not get sick. all i did was research how to flush the particles out of her body from the stratospheric aerosol geoengineering programs brought her D3 levels up to 80-100mg per ml in the blood stream and use ionic silver on the heavy days. both of us have not had a cold or flu for a decade now. pretty simple stuff.  

  3. Thanks you so much for explaining the topics very clearly. I wish you would add more topics commonly encountered in ambulatory and hospital setting.

  4. I've had a chronic cough for 2 years. I finally buckled down and went to the doctor. I was prescribed an inhaler and a nasal spray. Those, I imagine, are to differentiate whether it is allergies or asthma. I return in a month to see whether or not they work. 

  5. Good job. I've suffered for almost 3 months with a chronic cough after aspiration. The initial infection was cleared after a few days of antibiotics, but the cough never left. This video shed light on why my doctor ordered a bariatric test (to test for GERD), put me on Singulair (which can actually worsen GERD), and started me on asthma pills, even though I have no wheezing,. It all makes more sense now!

  6. I've got a cough that just won't go away and I'm taking cilazapril 5mg daily. Is this what's causing it? If so, what should I take as an alternative.

  7. Thank you so much for these videos; especially Chronic Cough, PFT etc. I've experienced almost annual Bronchial Pneumonia, or Bronchitis and Chronic Coughing lasting 3 – 4 months. 2 prescriptions of Antibiotics this year (Jan. and Mar. 2015). I am resisting family pressure and the traditional medicine approach to go for a third. I've joined a private clinic which practices an integrated medicine approach and we're investigating the 3 pronged causality outlined in your Chronic Cough video. I, at last, have hope. Thank you again.

  8. i like this video. you explained it clearly. I went to the doctor awhile ago and was diagnosed to have allergic rhinitis. now, i know what the doc was talking about. hahaha

  9. Thanks for this wonderful lecture. A point I wanted to mention was regarding the mechanism of cough in gerd. as far as I know the reason for cough is not regurgitation but it is because there are some receptors at the end of esophagus that can induce cough when reflax happens. thanks

  10. I'm under the asthma branch. I've had my chronic cough at least 1-2 times a year for about a decade now and after taking an allergy and MC test, no obvious trigger was found. I'm usually given an albuterol inhaler to subdue the cough. Most of the time it works, but I have to avoid either being out in dry/frigid air or exerting myself when it's at its worst.

  11. Glad I found u on here !! Wow love the videos , explains a lot and makes it easier to chat with my doctor 👍🏽👍🏽👍🏽 thanks again .

  12. Thanks, it would have been nice if you had also addressed about the remaining 43 % ….what could that be ? At least a pointer so we could search that up…

  13. What are other possibilities? I've been treated for all three of those with no effect. Allergy drugs/inhalers, omeprozole for GERD, Albuterol and asthma pills…also antibiotics and over-the-counter pills like Mucinex. I've been coughing for much of seven years now and nothing has helped, and doctors seem stumped. Don't know where to go from here…?

  14. I get embarrassed when I cough in public especially when I'm talking one one to a acquaintance. Like when I choked on my saliva while talking to my doctor. At home I don't care how often I cough.

  15. My doctor prescribed Gabapentin 100mg and it went away, after coughing for a year, now no more chronic coughing and no more Gabapentin

  16. I have chronic cough for a year, my doctor gave me chest X-ray (not thing), then Avamys 27.5 mg vap.nasal (not thing) , then DEXILANT 60mg (nothing), last week I had SIVEM AZITHROMYCINE 250 mg (my cough decreased 90%) but the chronic cough still exists. Can someone give me sommes tips please. It not easy to live with that sickness . I don’t have fever, cool never, just a bit itching in the throat and the cough start for 3 or 4 minutes 4 to 6 Time a day and I saw a lot stars around my eyes every time I cough.
    Thank you very much if you can give me sommes tips for cure my sickness. MUOI

  17. Well none of those were me I had chronic cough for 10 yrs finaly diagnosed with Sensory Neuropathic cough. After dr after dr Rx after Rx test after test.

  18. My husband has had a chronic cough for over 30 years. If he gets a cold or flu he coughs non stop all day long. It’s horrible for him but it is also horrible and embarrassing for me as everyone asks me what is he doing for his cough. We can’t go out as it is so loud and anti-social.

  19. I went to my doctor and at the end of the session I told my Doctor what to prescribe and I ended up being the doctor and my doctor became my patient!!

  20. Thank you so much. I can't explain how helpful this was. I went to several doctors and they examined my chest for asthma and they examined me for GERD on multiple occasions. But they could never figure out what was wrong with me. Your vid explained the symptoms and how to treat them. It's a "HUGE!!!!!!!!!!" relief. After treating the symptoms the cough is just gone. I can't express how much relief and the peace of mind that I have. After treatment I felt exhausted. I had a cough ever since I was very little. People used to stare and get annoyed by me. It was torture. I hated myself because I couldn't stop. Every "Doctor" was useless other than my current Doctor. It's a dramatic change. I can live.

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