“For chronic cough, two-thirds of these patients have multi-factorial contributions, whether it’s sinusitis and allergy or sinusitis and bronchitis—there’s more than one combination of more than one factor,” Dr. Altman said. “And that means you have to be comprehensive about how you work it up and how you treat it in order to get a good resolution of their problem.”
In discussing cases of chronic cough, panel members emphasized the importance of going deep into a patient’s history to try to get at medical clues that might be linked to the present problem. They also noted that when the otolaryngologist is sometimes the third physician called upon by the patient, there are challenges in relying on previous work-ups when necessary tools—such as a simple chest X-ray or a pulmonary function test—may not have been employed in a timely manner by other physicians. Consideration of international cases highlighted the fact that there is “no standardization of how to systematically approach the cough patient,” said Dr. Altman.
Jack Krouse, MD, PhD, chair of the department of otolaryngology head and neck surgery at Temple University in Philadelphia, talked about the importance of recognizing that everything is related. “We are really coming to the understanding and the realization that the respiratory tract works as a unified unit,” he said. “And anything you do to disturb one part of the respiratory system is going to have effects distal to that.” He urged the audience to “look at all the relative contributors: Look at the sinus, look at the nose, look at the lungs, look at the larynx, because of this shared inflammatory process that occurs across this entire tract.”