From Acute to Chronic Cough: Basic Guidelines and Recommendations

Amy Atkeson, MD, discussed the purpose of a cough, and the diseases and illness associated with it during her presentation, "Cough," held June 19 at Pri-Med NY.

Atkeson is an assistant professor of clinical medicine at Columbia University.

She kicked off her presentation by defining a cough as a “complex reflex arc,” and a “defense mechanism that clears upper and lower airway secretion, noxious substances, foreign bodies and infectious agents.” It can also be a warning sign of disease, she said.

Atkeson went on to highlight the types of nerve receptors involved: rapidly adapting nerve receptors (RARS), slow acting nerve receptors (SARs), and C-Fibers. RARs are activated when smelling cigarette smoke, acidity/alkalinity, pulmonary congestion, and more, she said.

Cough can be detrimental as well and cause sore throat, emesis, urinary incontinence, rib fracture, and more, she noted.

While cough is common, it is 3x more likely to be present in smokers and their children, she stressed. There are three types of cough considered: acute, which is a cough that has occurred for less than three weeks; subacute, which occurrs from three to eight weeks, and chronic, which lasts for longer than eight weeks.

It is important to ask patients two questions when they present with a cough issue: 1. Do they smoke? 2. Are they taking ACE-Inhibitors? Both are heavily associated with cough.

For patients taking ACE-I, cough is one of most common reasons for discontinuation of the treatment, she said.

Atkeson also discussed post infectious cough and explained that it is usually treated with inhaled ipatropium, inhaled corticosteroids, a steroid boost, or central acting antitussives as a last resort.

While the incidence of whooping cough has greatly decreased due to the introduction of the vaccine in the 1940s, since the 1980s it has been increasing, she said. With whooping cough, early intervention is necessary. Possible causes for the increase are waning immunity in adolescents and adults, incomplete immunity after immunization, and loss of natural immunity. The patient should be treated early and quarantined at home for at least five days, she said.