Cough is an important defense mechanism- reflex that aims to remove irritants and microorganisms. When, for example, you are cold, unnecessary mucus is eliminated and with it, many of the germs or viruses that have affected your respiratory system. When it lasts less than three weeks it is considered acute, and when it exceeds three weeks it is chronic and should always be investigated.
The chronic and persistent cough clinic is designed based on the knowledge that various factors are involved in coughing and only with the right diagnostic approach and monitoring can one have effective treatment. Our clinic provides an integrated approach with all the necessary diagnostic tests and at the same time, it cooperates with other specialties for better contribution where necessary, with the main goal of benefiting the patient.
Pulmonary evaluation and investigation of the Cough
The approach of coughing according to the guidelines of the European Respiratory Society, begins with the clinical examination and the detailed history taking. It is important to treat the cause of cough and to property assess it with the help of diagnostic tests and always in cooperation with the relevant specialties.
What may be causing your cough?
- Upper Airway Cough Syndrome (or postnasal drip syndrome) It is usually a dry and prolonged cough (as if trying to clear one’s throat). It may coexist with other symptoms from the nose or sinuses such as nasal congestion or runny nose and headache
- Asthma: It is one of the most common causes of chronic cough in children. Diagnosis will be based on symptoms, spirometry, bronchial challenge test with Metacholine and treatment response .
–Cough- variant asthma: It is a special type of asthma presented only with cough. It occurs mainly in the evening or after exercise or intense immune stimuli. Usually, spirometry before and after bronchodilation is normal. - Gastroesophageal reflux (GER): Cough may be the only symptom in a large proportion of patients and it may persist for several months, despite proper treatment. It is usually a dry cough throughout the day, with exacerbation mainly during the night hours during bedtime.
- Smoking
- Medications: Some antihypertensive drugs (angiotensin conversion enzyme inhibitors) may cause in a small percentage (1-2%) as a side effect, dry cough. Coughing may occur a few hours after taking the drug or even after weeks. Discontinuation of the drug and replacement is required. The cough will subside, although it may take several weeks.
- Post infectious: is generally due to previous upper or lower respiratory infections and can last up to 2 months.
- Foreign body: It is a common cause of cough, especially in children.
- Malignancies: Sometimes, coughing may be the only symptom of lung cancer. Changes in the character of coughing or the presence of bloody sputum are often early manifestations and are sought especially in heavy smokers.
Examinations
Chest X-ray
CT Chest
Spirometry before and after bronchodilation
Methacholine Provocation Test
X-ray or CT scan of sinuses
Bronchoscopy
Sputum culture and cytology
Esophagography- 24-hour monitoring of esophageal pH.
When is the right time for pulmonary evaluation?
Anyone coughing for a period of more than 2 weeks is recommended to be assessed by a pulmonologist. If the symptoms are persistent it is better to assess the problem earlier. Many conditions have a better response to treatment if treated in the early stages and this applies not only to coughing but also to lung diseases in general.
Treatment options Based on the history clinical examination and the results of the diagnostic tests your physician will inform you about the treatment plan according to the provisional diagnosis. It is important that the treatment is adhered to in detail and that the patient is reassessed at a specified time to check the response to treatment.
