Chronic Cough
Dr. Weyrich's Naturopathic Functional Medicine Notebook
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Overview
Chronic cough is a condition that concerns many patients. Fortunately, although a chronic cough can be associated with serious conditions such as cancer, most coughs are due to more benign causes that are amenable to treatment. Since there are many possible causes of chronic cough, proper diagnosis depends on a good patient history, supported by a variety of tests. In many cases, empirical trials are the most cost-effective, although time consuming, approach.Diagnosis
A number of laboratory tests may be useful as part of a diagnostic work-up, including:- Complete Blood Count (CBC) and Erythrocyte Sedimentation Rate (ESR).
- Chest X-ray.
- Tuberculin, Histoplasmin, Coccidiodin, and Blastomycin skin tests.
- Sputum smear and culture or (pneumonia, fungus, TB).
- Sputum eosinophils (asthma).
- Bronchial lavage for epsinophils and culture.
- Sweat Chloride Test (cystic fibrosis).
- alpha-1 Antitrypsin assay.
- Pulmonary Function Testing (spirometry).
- Arterial blood gas
- Barium swallow (hiatal hernia).
- Sputum cytology (cancer).
Differential Diagnosis
- Smoking.
- Angiotensin Converting Enzyme Inhibitor (ACE-I) syndrome.
- Upper Airway Cough Syndrome (post-nasal drip) due to inhaled allergens or chronic sinusitis.
- Gastroesophageal Reflux Disease
- Asthma, Chronic Obstructive Pulmonary Disease (COPD), Bronchiectasis, Interstitial, Restrictive, or other lung disease.
- Cystic fibrosis.
- Non-asthmatic eosinophilic bronchitis.
- Foreign-object aspiration.
- Enlarged tonsils or adenoids
- Esophageal or laryngeal anomalies.
- Hiatal hernia.
- Pharyngitis (pertussis, virus, strep, diptheria).
- Tuberculosis (TB), atypical mycobacterium infection, fungi, parasites, or other lung infection.
- Lung alpha-1 Antitrypsin deficiency.
- Congestive Heart Failure, pericarditis, aortic aneurysm, enlarged heart, mitral stenosis, or other space-occupying lesions in the mediastinum compressing the recurrent laryngeal nerve.
- Lung, laryngeal or esophageal cancer.
- Psychogenic (hysterical cough).
- Autoimmune disorders such as Wegener granuloma.
Treatment
- Screening TB-skin test and Chest X-ray are recommended.
- Smoking cessation.
- Change prescription ACE-I drug usage to ARB, or seek other method of controling hypertension.
- Treat possible underlying allergies.
- Treat possible underlying Gastroesophageal Reflux Disease (GERD)
- Referal for spirometry if asthma or other lung disease is suspected.
- Referal for upper GI endoscopy if esophageal or laryngeal anomalies are suspected.
- Referal for cardiovascular evaluation if other common causes have been ruled out.
ICD-9 Codes
| ICD9-Code | Description | Comments |
|---|---|---|
| 786.2 | Cough |
References
Unless specifically noted above, references used in the construction of this web page include the following:[FDM] Lecture notes from Functional Medicine University.
[SCNM] Lecture notes from Southwest College of Naturopathic Medicine.
[UT] Lecture notes from the University of Tennessee graduate programs in Chemistry and Biochemistry.
[Collins2003] R. Douglas Collins. Differential Diagnosis in Primary Care, Third Edition. Philadelphia: Lippincott Williams & Wilkins (2003).
[Domino2008] Frank J. Domino. The 5-Minute Clinical Consult 2008, 16th Edition. Philadelphia: Lippincott Williams & Wilkins (2008).
Copyright © 2007-2010 Dr. Weyrich (Naturopathic Medical license number 07-1008). The information on this site is for educational purposes only. It is not intended to diagnose, treat or cure any disease or illness. The statements on this website have not been evaluated by the Food and Drug Administration.
This web page is http://www.DrWeyrich.com/disorders/cough.html - Phone Dr. Weyrich at (480) 423-6952