Why is chronic cough high in respiratory medicine? Why is chronic cough easy to ignore? Why should chronic cough not be treated with antibiotics? In respiratory clinics, more than 80% of patients complain of persistent cough. With the approach of the ninth day of the year, the condition of these patients may worsen, and respiratory clinics become increasingly stressed. Why is a chronic cough easy to ignore? A cough can be chronic even if there is no abnormality on the X-ray chest X-ray. Coughs are usually divided into three categories according to time: acute cough, subacute cough and chronic cough. Acute coughs last less than 3 weeks, subacute coughs last 3-8 weeks, and chronic coughs last longer than 8 weeks. Chronic cough has many causes and is usually divided into two categories based on the presence or absence of abnormalities on chest x-ray. One category is those with obvious lesions on chest X-ray, such as pneumonia, tuberculosis, bronchopulmonary cancer, etc. The other category is those with no obvious abnormalities on chest X-ray and cough as the main or only symptom, which is usually referred to as unexplained chronic cough. Cough has a defensive function of removing foreign bodies from the respiratory tract; however, cough is also a sign of disease. Chronic cough can cause many hazards, including cardiovascular, gastrointestinal, genitourinary, neurological, skeletal-muscular, and respiratory complications. First, prolonged and frequent coughing can cause damage to the airway mucosa, and this damage to the airway mucosa can exacerbate the cough. Second, repeated violent coughing can cause a very high intrapulmonary pressure, which can cause or exacerbate the formation of emphysema and even the development of pneumothorax. Again, increased intrapulmonary pressure can lead to a decrease in the amount of blood returned to the heart, which in turn can lead to a decrease in cardiac output and insufficient blood supply to the brain, causing clinical symptoms of cough syncope. Why is there a high incidence of chronic cough? Chronic cough is associated with other systemic diseases Common causes of chronic cough include: cough variant asthma (CVA), upper airway cough syndrome (UACS), eosinophilic bronchitis (EB) and gastroesophageal reflux cough (GERC). These etiologies account for 70% to 95% of the causes of chronic cough in respiratory medicine outpatient clinics. Other etiologies are less common but are widely involved and are associated not only with respiratory diseases but also with diseases of other systems. UACS is a syndrome in which nasal diseases cause secretions to back up behind the nose and throat, which directly or indirectly stimulate cough receptors, resulting in a cough as the main manifestation.UACS is one of the most common causes of chronic cough. In addition to nasal diseases, UACS is often associated with diseases of the throat, such as allergic or non-allergic pharyngitis, laryngitis, pharyngeal neoplasia, and chronic tonsillitis. CVA is a specific type of asthma in which cough is the only or main clinical manifestation. It has no obvious signs or symptoms such as wheezing and shortness of breath, but has airway hyperresponsiveness. The main manifestation is an irritating dry cough. patients with CVA usually have a more violent cough, and nocturnal cough is an important feature. Cold, cold air, dust and fumes can easily trigger or aggravate the cough. EB is a non-asthmatic bronchitis characterized by airway eosinophil infiltration and negative airway hyperresponsiveness. The main manifestation is a chronic cough that responds well to glucocorticoid therapy. The main symptom is a chronic irritating cough with dry or little white mucus sputum, which may be present during the day or at night. Some patients are sensitive to fumes, dust, odors or cold air, which are often triggering factors for coughing. Patients do not have symptoms such as shortness of breath or dyspnea. GERC is a clinical syndrome caused by reflux of gastric acid and other gastric contents into the esophagus, resulting in a cough as a prominent manifestation. It belongs to a specific type of GERD and is a common cause of chronic cough. Typical reflux symptoms manifest as heartburn (burning sensation behind the sternum), acid reflux, and belching. Some GERD-induced coughs are accompanied by typical reflux symptoms, but many patients have cough as the only manifestation. The cough mostly occurs in the daytime and in the upright position, with a dry cough or a small amount of white mucous sputum. Eating acidic, oily foods tends to trigger or aggravate the cough. Why is it not treated with antibiotics? Chronic cough is not associated with infection Most chronic coughs are not associated with infection and do not need to be treated with antibacterial drugs. Use oral or intravenous glucocorticoids with caution when the cause of the cough is unknown or when infection cannot be excluded. Empirical treatment of chronic cough means that in cases where the etiological diagnosis is uncertain, appropriate treatment measures are given according to the condition and the possible diagnosis, and the diagnosis is established or excluded by the response to treatment. Empirical treatment should be based on the following principles. Firstly, treatment should be directed at the common causes of chronic cough. The results of domestic and international studies show that the common causes of chronic cough are CVA, UACS, EB and GERC. The possible etiology of chronic cough is inferred from the medical history. If the patient’s main manifestation is irritating cough at night, the patient can be treated as CVA first; if the cough is accompanied by significant acid reflux, belching and heartburn, the patient is considered to be treated as GERC; if the cough persists secondary to a cold, the patient can be treated as post-infectious cough; if the cough is accompanied by runny nose, nasal congestion, nasal itching and frequent throat clearing, the patient is treated as UACS first. Empirical treatment with a wide coverage of moderately priced compound preparations, such as Myminerald’s pseudo-anesthetic solution and compound methoxynamine, is recommended. These preparations are useful in the treatment of UACS, allergic cough, and post-infectious cough. Those with suspected CVA and EB can be treated with oral hormone therapy for 3 to 5 days first, and then switch to glucocorticoid therapy after the symptoms are relieved. Those with cough, coughing up thick sputum or thick runny nose can be treated with antibiotics. Most chronic cough etiologies are not related to infectious etiologies and empirical treatment should avoid abuse of antibiotics. Empirical treatment is often 1 to 2 weeks for UACSS, CVA, and EB, and at least 2 to 4 weeks for GERC. Oral glucocorticoids are usually administered for no more than 1 week. If empirical treatment is effective, continue with the standardized treatment protocol for the appropriate cough etiology. Those whose empirical treatment is ineffective should promptly go to a qualified hospital for relevant investigations to clarify the etiology. Follow up closely to avoid missing early bronchial malignancies, tuberculosis and other lung diseases. Warm tips As coughs persist, patients may go to multiple hospitals and have the same items checked repeatedly. In fact, chronic cough is a disease involving multiple systems throughout the body, and fixing the same doctor or the same hospital may be more helpful in the observation and differential diagnosis of the disease.