LAM Extra for General Practicioners

[CHRONIC COUGH - THE OTOLARYNGOLOGISTS’ POINT OF VIEW]

GERLINGER Imre

OCTOBER 12, 2009

LAM Extra for General Practicioners - 2009;1(04)

[Chronic cough can have a profound impact on the psychosocial function of patients. Most studies agree that post-nasal drip syndrome (PNDS), asthma, gastro-esophageal reflux disease (GERD), and laryngo-pharyngeal reflux (LPR) are the most common causes of chronic cough in immunocompetent, non-smoking patients who are not taking angiotensin-converting enzyme (ACE) inhibitors and present with a negative chest x-ray. No diagnostic test has yet been found to define those who have PNDS other than the response to a first-generation antihistamine. Examination of the available evidence suggests that the theory of mechanical stimulation of the pharynx by mucus does not explain the occurrence of cough. Inflammatory mediators’ levels in the lower airways are higher in PNDS, cough variant asthma, and GERD, and the theory that an inflammatory process is affecting “one airway” is a plausible one. Nasal disease is more likely to result in cough from the co-existing involvement of the lower airways through a yet undefined pathway. Mediation by eosinophil and mast cells appears to be a likely mechanism. In this paper, the author summarizes all potential pulmonological, otolaryngological and other reasons of chronic cough, suggesting a systematic therapeutic algorithm.]

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