The Curbsiders Internal Medicine Podcast

#241 Chronic Cough

14 snips
Nov 9, 2020
Guest
Brad Hayward
Dr. Brad Hayward, a pulmonologist and palliative care physician from Weill Cornell Medicine, dives into the complexities of chronic cough. He breaks down the definitions and common causes, including upper airway cough syndrome and cough-variant asthma. Expect insights on post-viral cough management and tips for effective patient communication. Hayward emphasizes the importance of tailored treatment approaches and understanding environmental triggers. This episode is a goldmine for those grappling with respiratory challenges!
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INSIGHT

GERD Can Cause Cough Without Typical Heartburn

  • Acid reflux can trigger cough via esophageal‑tracheal neural crosstalk, not only by aspiration.
  • Trial a PPI even without classic reflux symptoms when GERD is on the differential.
ADVICE

Treat Post‑Viral Cough Pragmatically

  • For suspected post‑viral cough try intranasal steroid for rhinitis and an inhaled corticosteroid for airway hypersensitivity for 4–6 weeks.
  • Use short‑acting bronchodilator only for situational triggers (e.g., exercise, cold exposure).
ADVICE

Begin With CXR And Spirometry

  • Start evaluation with chest x‑ray and office spirometry to rule out structural disease and obstruction.
  • Reserve full PFTs, CT with inspiratory/expiratory views, and DLCO when initial tests or history suggest abnormality.
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