Dr Peter Dicpinigaitis Explains the Process of Diagnosing Refractory Chronic Cough

Patients with a cough lasting more than 8 weeks are diagnosed with chronic cough, and for a subpopulation of those patients there is no treatable underlying cause of their cough, said Peter Dicpinigaitis, MD, chair of the American Cough Conference, professor of medicine at the Albert Einstein College of Medicine, director of the Montefiore Cough Center, and editor-in-chief of LUNG.

Transcript

Cough is a common issue for patients. How is chronic cough diagnosed typically?

For those new to the cough space, it's important to understand the definitions and the most commonly accepted definitions based on what multiple of our societies accept as definitions are that an acute cough is a cough of less than 3 weeks duration; a chronic cough is a cough of more than 8 weeks duration; and the middle road 3 to 8 weeks would be a subacute cough.

So, we spend most of our time talking about chronic cough because that's where the need is. The important thing about chronic cough is it's simply a cough that's been around for more than 8 weeks. And for a physician, the initial job is to look for potential underlying and treatable causes of that chronic cough. The 3 most common ones being what we call upper airway cough syndrome, previously known as post-nasal drip syndrome. Number 2 would be asthma and asthma-like condition. And number 3 is reflux.

So, the first job of the clinician is to try to identify one of those underlying causes and treat them. But there is a significant subpopulation of patients who do not respond to treatment of these potential underlying causes. Once we get there, then the appropriate diagnosis of that cough is a refractory chronic cough. Because that cough has failed empiric treatment against reversible causes of cough.

Who typically diagnosis chronic cough? Is it specialists or are primary care physicians able to?

I run one of the few chronic cough specialty centers in United States, so I tend to see the most difficult or refractory patients, who have been coughing maybe for 10, 20 years and have seen 10 or 12 doctors. That's kind of a common journey, unfortunately, for our chronic cough patients.

Unfortunately, though, I meet patients who have been coughing for years but still really haven't undergone a thorough basic evaluation for those underlying causes that I mentioned. So even though guidelines were published and exist I think there's still plenty of opportunity in our fields for education of our physicians who treat chronic cough. And that is not just the primary care physicians, but then the specialists, which would most likely be pulmonologist, allergists, ENT [ear, nose, and throat] physicians, and gastroenterologist.