Chronic cough is a common diagnostic and therapeutic problem. The exact prevalence has proved difficult to estimate and recurrent cough is reported by 3–40% of the population.
Chronic cough is clearly a very common symptom which, although associated with considerable morbidity, goes largely unheeded.
The reasons why patients seek advice regarding chronic cough are not fully understood, but may be related to worry about the cough. Often, cough related morbidity—in terms of sleep disturbance (either of the patient or their relatives), urinary incontinence in women, or syncope—drives the patient to consult. Indeed, chronic cough has been shown to be associated with a marked deterioration in quality of life which returns to normal on successful treatment.
In population surveys, men have reported cough more frequently. However, most
patients referred to specialist cough clinics are women. This paradox may be explained by differences in smoking habit, but women also appear to have an intrinsically heightened cough response.
Classically, cough lasting less than 3 weeks has been considered as acute and that of more than 3 weeks duration has been defined as chronic. In recent years there has been a tendency to redefine chronic cough as cough lasting more than 8 weeks and, for further clarification, the term ‘‘subacute cough’’ was proposed to describe cough lasting 3–8 weeks. While these definitions remain arbitrary, the concept of chronic cough remains clinically important.
Here we highlight 2 cases of chronic cough which on proper history taking and clinical examination and appropriate investigations threw light on the exact etiology.
Case 1: RS - 15 year old Girl studying in 10th standard, premorbid history normal, came with chief complaints of predomintly dry cough more in the nights for the last 15 days, frequent sneezing and rhinitis all throughout the year. No breathlessness. No other symptoms. On examination, vitals stable, chest clear. WBC Count revealed 10 % eosinophils, Absolute Eosinophil Count of 700. Serum IgE was done by another referral practitioner—350 IU.
Patient was started on Tablet Hetrazan and Asthalin MDI. Chest X Ray done at the beginning of the illness was normal. Patient was continued on same medications, however started developing increased cough in the nights and low
grade fever. Then patient was referred to me. Fresh Chest X-Ray revealed Right lower zone paracardiac consolidation. Patient was admitted and started on IV Amoxicillin Clavulanic Acid. Sputum SCABS and AFB three samples were sent in view of chronic cough.
before the treatment
Chronic cough is clearly a very common symptom which, although associated with considerable morbidity, goes largely unheeded.
The reasons why patients seek advice regarding chronic cough are not fully understood, but may be related to worry about the cough. Often, cough related morbidity—in terms of sleep disturbance (either of the patient or their relatives), urinary incontinence in women, or syncope—drives the patient to consult. Indeed, chronic cough has been shown to be associated with a marked deterioration in quality of life which returns to normal on successful treatment.
In population surveys, men have reported cough more frequently. However, most
patients referred to specialist cough clinics are women. This paradox may be explained by differences in smoking habit, but women also appear to have an intrinsically heightened cough response.
Classically, cough lasting less than 3 weeks has been considered as acute and that of more than 3 weeks duration has been defined as chronic. In recent years there has been a tendency to redefine chronic cough as cough lasting more than 8 weeks and, for further clarification, the term ‘‘subacute cough’’ was proposed to describe cough lasting 3–8 weeks. While these definitions remain arbitrary, the concept of chronic cough remains clinically important.
Here we highlight 2 cases of chronic cough which on proper history taking and clinical examination and appropriate investigations threw light on the exact etiology.
Case 1: RS - 15 year old Girl studying in 10th standard, premorbid history normal, came with chief complaints of predomintly dry cough more in the nights for the last 15 days, frequent sneezing and rhinitis all throughout the year. No breathlessness. No other symptoms. On examination, vitals stable, chest clear. WBC Count revealed 10 % eosinophils, Absolute Eosinophil Count of 700. Serum IgE was done by another referral practitioner—350 IU.
Patient was started on Tablet Hetrazan and Asthalin MDI. Chest X Ray done at the beginning of the illness was normal. Patient was continued on same medications, however started developing increased cough in the nights and low
grade fever. Then patient was referred to me. Fresh Chest X-Ray revealed Right lower zone paracardiac consolidation. Patient was admitted and started on IV Amoxicillin Clavulanic Acid. Sputum SCABS and AFB three samples were sent in view of chronic cough.before the treatment
Sputum SCABS revealed Staphylococcus Aureus and AF
B was negative for all samples.
Patient improved dramatically on antibiotics and subsequent Chest X- Ray showed complete clearance of shadows.
B was negative for all samples.Patient improved dramatically on antibiotics and subsequent Chest X- Ray showed complete clearance of shadows.
After treatment
Case 2: SM - 34 year old Female, premorbid history normal, came with chief complaints of cough predominantly dry for the last 3 months. She 
also gave history of frequent rhinitis, cold and also allergy to dust, fumes and history of getting rashes and wheals on and off. Patient was treated by local
also gave history of frequent rhinitis, cold and also allergy to dust, fumes and history of getting rashes and wheals on and off. Patient was treated by local family practitioner with anti histaminics. However
Three months before the patient had no relief and was referred to a 
specialist. However again was given cough syrup,
inhalers and CXR and PFT done which was normal. Then the patient was referred to me for unremitting cough.
Earlier CXR on review showed left lower zone
Earlier CXR on review showed left lower zone
on presentation reticular opacities and the follow up fresh CXR showed bilateral lower zones interstitial opacities. Her PFT on review also showed Mild restriction suggestive of a restrictive disorder like Interstitial Lung disease. HRCT was suggestive of bilateral ground glassing with right middle lobe consolidation and Fibreoptic Bronchoscopy was done where biopsy revealed Interstitial Lung disease. Patient was started on steroids and showed dramatic improvement in cough. 
Thus, chronic cough on proper history taking, clinical examination and appropriate investigations is curable. Further cases on chronic unremitting cough will be in the next editions.
Thus, chronic cough on proper history taking, clinical examination and appropriate investigations is curable. Further cases on chronic unremitting cough will be in the next editions.
- Dr. Subramanian Natarajan M.D (ChestMed.) 9870566767
2 comments:
Can Interstitial Lung disease really be treated by using steroids? My friend's aunt is diagnosed with Interstitial Lung disease and is hospitalized at Wockhardt hospital in mulund. She's on artificial oxygen and cannot live without it. Can Interstitial Lung disease really be treated? Please help.
Thanks
Thomas
interesting article about chronic cough, but did you know that there is an alternative way to have a healthy lungs? just connect with me and I will tell you :)
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