Diagnosis and treatment of common causes of chronic cough

  Chronic cough is a common symptom in respiratory patients and affects their work, study and social activities. There are many causes of chronic cough, which require careful history taking, careful physical examination, and selection of appropriate ancillary tests to clarify the diagnosis and thus the appropriate treatment. The treatment of the most common causes of chronic cough is briefly described as follows: Cough variant asthma is a specific type of asthma in which cough is the only or main clinical manifestation. It mainly manifests as an irritating cough, usually more intense, with nocturnal cough as an important feature. Cold, cold air, dust and fumes can easily trigger or aggravate the cough. Bronchial provocation test, bronchodilatation test or peak expiratory flow rate measurement can be helpful for diagnosis. Treatment with inhaled glucocorticosteroids combined with bronchodilators can be applied and, if necessary, a short course of oral low-dose glucocorticosteroids can be administered. The duration of treatment should be greater than 8 weeks.  Upper airway cough syndrome is a common cause of chronic cough. It involves various diseases of the nose, sinuses, pharynx and larynx. In addition to cough and sputum, it may also manifest as nasal congestion, increased nasal discharge, sneezing, clear nasal discharge, and pharyngeal itching. In some patients, cough is seasonal and allergen (allergen) determination is helpful for diagnosis. Depending on the cause, antihistamines and nasal inhalation glucocorticoids can be applied for treatment. Avoiding or reducing exposure to allergens can help reduce symptoms, and specific allergen immunotherapy (desensitization) can also be performed. Anti-infective therapy should be administered for bacterial sinusitis.  Gastroesophageal reflux cough is caused by reflux of stomach acid or other gastric contents into the esophagus and is also a common cause of chronic cough. In addition to gastric acid, bile reflux is also associated with it in a few patients. Clinical manifestations include a burning sensation behind the sternum, acid reflux, belching, and cough. Consumption of acidic and fatty foods tends to trigger or aggravate the cough. Patients should adjust their lifestyle and diet, and can be treated with acid-control drugs (e.g. omeprazole) and gastroprokinetic drugs (e.g. domperidone).