Table 2.
Management of chronic cough
| Cause | Therapy | Remark |
|---|---|---|
| Cigarette smoking | Cessation of smoking | Leads to a dramatic decrease in cough within 1 month |
| Occupational exposure (e.g. dust, fumes, other irritants) | Reduction of exposure | Wearing a face mask, improving air circulation, a change of job may be necessary |
| Postnasal-drip syndromes Nonallergic rhinitis | Combination of older-generation of antihistamines and decongestants | Newer generation of histamine antagonists are inferior in treating cough but avoid sedation |
| Ipratropium (0.06%) nasal spray for 3 weeks | Mainly for patients who cannot take the older-generation of antihistamines | |
| Nasal steroids | Nasal steroids should be added, if cough is not controlled by antihistamine-decongestant medication or persist 1–2 weeks | |
| Vasoconstrictor e.g., oxymetazolone | Vasoconstrictor should not be used for more than 5 days | |
| Chronic bacterial sinusitis | Antibiotics Older-generation antihistamine-decongestant combination | If sinus infection is suspected, appropriate antibiotics may also be ordered. The selection and duration of the antibiotic treatment is individual. |
| Allergic rhinitis | Avoidance of offending allergens, Newer-generation antihistamines | |
| Hypersensitivity that follows an upper respiratory infection (as in the so-called cough variant asthma) | Antihistamines, inhaled steroids – if unresponsive to treatment with an antihistamine, dextromethorphan or codeine | Present only on a chronic, usually non-productive cough, a positive result on metacholine challenge, physical examination out of periods with acute symptoms is essentially normal |
| Chronic bronchitis | Discontinuation of smoking Avoidance of enviromental irritants and toxins | In this case we prefer ipratropium in the therapy of cough, because it decreases mucus production, dilates the bronchi and is more effective in the therapy of cough than beta-agonists |
| Preventive health measures (e.g. immunizations with pneumococcal vaccine, annual influenza vaccinations) | ||
| Treatment of community-acquired respiratory infections | ||
| Optimal bronchodilatory therapy, | ||
| Postural drainage and hydration, | ||
| Correction of malnutrition, | ||
| Oral steroid therapy, if it is necessary | ||
| Inhaled ipratropium | ||
| Asthma bronchiale | Avoidance of allergens, | Typical syndromes: |
| Prophylactic inhalation: | —dyspnea | |
| Cromolyn, | —coughing | |
| Beta-agonist and/or | —wheezing | |
| Steroid inhalers, or | Some times it is necessary to have long-term maintenance | |
| Oral corticosteroids, if required | therapy with anti-inflammatory drugs. | |
| Drugs induction: | -Withdrawal of drug, | Cough occurs in 5–20% of |
| -Angiotensin-converting enzyme inhibitors (ACEI) | -Sulindac, | patients treated with ACEI, |
| -Indometacin, | ||
| -Calcium channel blockers (e.g. nifedipine, dilthiazem), | ||
| -Alternative class of drugs, | ||
| Beta blockers | -Withdrawal of drug, | Beta-blockers can cause increased airway resistance resulting from unopposed parasympathetic activity |
| -Substitute a drug from a different class | ||
| Gastroesophageal reflux (GERD) | High doses of proton-pump inhibitors, e.g. omeprazole | Omeprazole, in a dose of 80 mg per day |
| -Anticholinergic drugs | As is necessary | |
| -Calcium channel blockers | As is necessary | |
| -Theophylline | As is necessary | |
| -Other muscle relaxants | As is necessary | |
| -Protective agent, e.g. sucralfate | Sucralfate may be helpful in a dose of 1 g taken one hour before meals | |
| -Prokinetic agent, e.g. metoclopramide or cisapride before meals and at bedtime | Metoclopramide or cisapride may be added before meals and at bedtime, necessary to avoid eating or drinking for 2 h before sleeping |