Explore common clinical presentations of chronic cough1
Men and women are affected, but patients are typically females in their 50s2
Patients typically have a nonproductive cough that can last for months or years2,3
Cough hypersensitivity is a common characteristic among patients with refractory or unexplained chronic cough and includes4
ALLOTUSSIA is a hypersensitive response triggered by nontussive stimuli not normally sufficient to cause cough, such as cold air, singing or talking, and fatigue or stress4,5,6
HYPERTUSSIA is another form of cough hypersensitivity, which can be characterized as a cough triggered by smaller amounts of known cough-inducing stimuli4,5,6
These responses to stimuli (allotussia and hypertussia) can sometimes trigger an uncontrollable bout of coughing5
Explore hypothetical patient profiles below to learn more about each patient’s medical history, workup and diagnosis.
Daphne experiences frequent uncontrollable coughing bouts throughout the day.
Presentation
- 56-year-old with persistent dry cough for 1 year
Medical History
- Impact limits social gatherings
- Nonsmoker
- Diagnosed with asthma in her 20s
- Stress urinary incontinence
- Has visited multiple specialists for her chronic cough, without resolution
- No red flags,a environmental exposure, or medications known to cause cough (eg, ACE inhibitors) were identified
Evaluation
- Thorough diagnostic workup did not identify any cough-associated conditions other than asthma
Diagnosis
- Refractory chronic cough (RCC): Chronic cough that persists despite appropriate treatment for her cough-associated asthma
aRed flags include: Hemoptysis; smoker >45 years of age with a new cough, change in cough, or coexisting voice disturbance; adults aged 55-80 years who have a 30 pack-year smoking history and currently smoke or who have quit within the past 15 years; prominent dyspnea, especially at rest or at night; hoarseness; systemic symptoms, including: fever, weight loss, and/or peripheral edema with weight gain; trouble swallowing when eating or drinking; vomiting; recurrent pneumonia; abnormal respiratory exam and/or abnormal chest radiograph, coinciding with duration of cough.7
ACE, angiotensin converting enzyme; GERD, gastroesophageal reflux disease; UACS, upper airway cough syndrome; NAEB, nonasthmatic eosinophilic bronchitis.
Michael is frustrated by his cough, especially when it interrupts his conversations.
Presentation
- 51-year-old with persistent dry cough for 6 months
- Uncontrollable coughing bouts with no triggers reported
- No shortness of breath but mild wheezing present
- Occasional sleep disruption
Medical History
- Previously diagnosed with mild asthma >20 years ago with treatment according to established asthma guidelines
- No red flags,a environmental exposure, or medications known to cause cough (eg, ACE inhibitors) were identified
Evaluation
- Pulmonary function test results suggest some decrease in lung function, consistent with asthma
- Normal chest x-ray
Management and Follow-up
- Cough significantly improved after 6 weeks following adjustments to current therapy, as well as counseling on proper inhaler technique
Diagnosis
- Mild persistent asthma
aRed flags include: Hemoptysis; smoker >45 years of age with a new cough, change in cough, or coexisting voice disturbance; adults aged 55-80 years who have a 30 pack-year smoking history and currently smoke or who have quit within the past 15 years; prominent dyspnea, especially at rest or at night; hoarseness; systemic symptoms, including: fever, weight loss, and/or peripheral edema with weight gain; trouble swallowing when eating or drinking; vomiting; recurrent pneumonia; abnormal respiratory exam and/or abnormal chest radiograph, coinciding with duration of cough.7
ACE, angiotensin converting enzyme; GERD, gastroesophageal reflux disease; UACS, upper airway cough syndrome; NAEB, nonasthmatic eosinophilic bronchitis.
Jasmine’s family is concerned by her uncontrollable bouts of coughing and they have urged her to seek answers.
Presentation
- 56-year-old with persistent dry cough for more than 5 years
- Sensation of irritation in the throat precedes her uncontrollable bouts of coughing
Medical History
- Nonsmoker
- Has visited multiple specialists for her chronic cough, without resolution
- No red flags,a environmental exposure, or medications known to cause cough (eg, ACE inhibitors) were identified
- Previously seen by ENT; sinus workup and sinus CT scan results were unremarkable
Evaluation
- Thoroughly evaluated for asthma, GERD, UACS (postnasal drip), and NAEB; findings were unremarkable and empiric treatments did not resolve her cough
Diagnosis
- Unexplained chronic cough (UCC): Chronic cough with no underlying conditions identified, despite a thorough diagnostic workup
aRed flags include: Hemoptysis; smoker >45 years of age with a new cough, change in cough, or coexisting voice disturbance; adults aged 55-80 years who have a 30 pack-year smoking history and currently smoke or who have quit within the past 15 years; prominent dyspnea, especially at rest or at night; hoarseness; systemic symptoms, including: fever, weight loss, and/or peripheral edema with weight gain; trouble swallowing when eating or drinking; vomiting; recurrent pneumonia; abnormal respiratory exam and/or abnormal chest radiograph, coinciding with duration of cough.7
ACE, angiotensin converting enzyme; GERD, gastroesophageal reflux disease; UACS, upper airway cough syndrome; NAEB, nonasthmatic eosinophilic bronchitis.
Violet has recently started to complain about increased fatigue, lack of strength, and a bothersome cough.
Presentation
- 61-year-old with persistent cough for 3 months
- Dry, nonproductive cough several times per day
- Recent unintentional weight loss (~10 lbs.)
- Fatigue
- Chest pain on deep inhalation or cough
Medical History
- Former smoker: 1 pack/day for 30 years, quit 10 years ago
- Red flagsa present: recent weight loss and smoking history
- No environmental exposure or medications known to cause cough (eg, ACE inhibitors) were identified
Evaluation
- Chest CT ordered, referred for follow-up of radiologic findings
- Chest x-ray: abnormal opacity in upper left lobe
- High-resolution computed tomography (HRCT) of the chest: results were consistent with lung cancer
- Lung tissue biopsy: abnormal cytology consistent with non–small cell lung cancer
Diagnosis
- Non–small cell lung cancer (NSCLC)
aRed flags include: Hemoptysis; smoker >45 years of age with a new cough, change in cough, or coexisting voice disturbance; adults aged 55-80 years who have a 30 pack-year smoking history and currently smoke or who have quit within the past 15 years; prominent dyspnea, especially at rest or at night; hoarseness; systemic symptoms, including: fever, weight loss, and/or peripheral edema with weight gain; trouble swallowing when eating or drinking; vomiting; recurrent pneumonia; abnormal respiratory exam and/or abnormal chest radiograph, coinciding with duration of cough.7
ACE, angiotensin converting enzyme; GERD, gastroesophageal reflux disease; UACS, upper airway cough syndrome; NAEB, nonasthmatic eosinophilic bronchitis.
References: 1. Morice AH et al. Eur Respir J. 2020;55:1901136. 2. Satia I et al. Clin Med (Lond). 2016;16(Suppl 6):S92-S97. 3. Smith JA, Woodcock A. N Engl J Med. 2016;375:1544-1551. 4. Kardos P et al. Postgrad Med. 2021;133:481-488. 5. Mazzone SB et al. Lancet Respir Med. 2018;6:636-646. 6. Song WJ, Chang YS. Clin Transl Allergy. 2015;15:24. 7. Irwin RS et al. Chest. 2018;153:196-209. 8. Kuzniar TJ et al. Mayo Clin Proc. 2007;82:56-60. 9. Mayo Clinic Staff. Mayo Clinic website. https://www.mayoclinic.org/ diseases-conditions/chronic-cough/symptoms-causes/syc-20351575. Accessed July 6, 2022. 10. French CL et al. Arch Intern Med. 1998;158:1657-1661. 11. Dicpinigaitis PV et al. Chest. 2006;130:1839-1843.
