forced explosive manoeuvre, usually against closed glottis, associated with characteristic sound

chronic > 8wks

  • 10-20%

  • more common in women and overweight people

  • physical

  • psychological effects

Common causes

Asthma

  • may be one on main presenting features

  • airway hyper-responsiveness usually present

  • eosinophilic bronchitis cause cough

    • sputum eosinophilisa > 3%

    • PEFR variability and airway hyper-responsiveness not present

    • considered form of asthma

GORD

  • can occur in absence of marked GI symtoms

  • may be possible cause of chronic cough

  • uncertain mech.

    • increase cough reflex sensitivity

    • micro-aspiration

  • provoked by talking, laughing, singing

  • lack of diaphragmatic closure of the lower oesophageal sphincter

Post nasal drip

  • cough and clear throat frequently

Other

  • COPD

  • lung cancer

  • Bronchiectasis

  • Tb

  • Mediastinal tumours

  • Pulmonary fibrosis

  • Inhalation of FB

  • Airway irritants

    • tobacco smoke, dust, fumes

  • Chronic aspiration

    • 2ary to neuromusclar duysfuntion

ACEi

  • 5-10% of exposed

  • cough should settlie within 1 month

Idiopathic chronic cough

  • diagnosis of exclusion

  • 20%

  • female, middle aged

  • honking/barking

Investigations

  • CXR

  • Spirometry

Specialist investigations

  • bronchial provocation tests

  • Bronchoscopy

  • layngoscopy

  • HRCT

  • sputum - eosinophils

  • Oesophageal pH monitoring