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Unexplained cough in the adult.
1Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA. irwinr@ummhc.org
Otolaryngologic Clinics of North America
|February 23, 2010
Summary
Unexplained chronic cough requires a thorough diagnostic evaluation and treatment protocol. Even with heightened cough sensitivity, effective management strategies can resolve most troublesome cough cases.
Area of Science:
- Pulmonology
- Clinical Medicine
Background:
- Unexplained chronic cough is a diagnosis of exclusion.
- It requires a comprehensive diagnostic evaluation and failure of appropriate treatments before diagnosis.
- Uncommon causes must be ruled out.
Purpose of the Study:
- To outline the diagnostic and management protocol for unexplained chronic cough.
- To emphasize the importance of validated protocols and avoiding management pitfalls.
- To discuss the role of cough reflex sensitivity and available treatment options.
Main Methods:
- Review of diagnostic evaluation and treatment protocols for chronic cough.
- Assessment of management pitfalls in troublesome cough cases.
- Evaluation of heightened cough reflex sensitivity in patients.
Main Results:
- Truly unexplained chronic cough should not exceed 10% after proper evaluation.
- Heightened cough sensitivity is common in chronic cough but not the sole explanation for non-resolution.
- Validated management protocols and avoiding pitfalls are crucial.
Conclusions:
- Referral to specialized cough clinics, speech therapy, and evidence-based pharmacotherapy are key management options.
- Randomized, double-blind, placebo-controlled trials guide drug selection for unexplained chronic cough.
- A systematic approach ensures effective management of most chronic cough cases.
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