Korean J Med.
2017 Dec;92(6):506-513. 10.3904/kjm.2017.92.6.506.
Misunderstandings and Truth about Chronic Cough
- Affiliations
-
- 1Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea. chestor@hallym.or.kr
- KMID: 2400914
- DOI: http://doi.org/10.3904/kjm.2017.92.6.506
Abstract
- There seem to be several pitfalls in an anatomic, diagnostic protocol for the evaluation of chronic cough. Instead, it is reasonable to propose that non-asthmatic chronic cough depends on the combined effects of an underlying, abnormally enhanced cough reflex and aggravating factors. Unexplained chronic cough is distressingly common despite a systematic diagnostic approach. It is often related to bronchial hypersensitivity and nonspecific bronchial inflammation. Inhaled corticosteroid (ICS) is effective for asthmatic cough. ICS is less effective in non-asthmatic cough than in asthma but not ineffective. It can be modestly effective in a significant portion of patients with non-asthmatic cough. Cough itself can induce upper airway mucosal inflammation, which could enhance the cough reflex and viciously aggravate cough. Therefore, an antitussive agent is not a just symptom controller but can play a major role in successful cough control. Cough can be more effectively controlled by behavioral interventions, with psychological counseling in addition to a pharmacological approach. ICS and antihistamines can reduce cough regardless of its cause, so therapeutic diagnosis is a misconception in the diagnosis of cough.
