Cough Specialists Collaborate for an Interdisciplinary Problem









Kenneth W. Altman, MD, PhD Guest Editor





Richard S. Irwin, MD Guest Editor
Both acute and chronic cough are responsible for a significant portion of ambulatory medical visits annually (about 3%), over-the-counter self-medication expenses in excess of $3.6 billion in the United States, and impaired quality of life. The diagnosis of cough can be simple or profoundly challenging. This ranges from a solitary cause such as allergic rhinitis, to multifactorial and synergistic contributions, to a physiologic mystery that may ultimately impair respiratory function and hinder one’s way of life. One unique aspect of this chronic cough is that it is an indicator of underlying disease, rather than being a disease itself.


Thus, as clinicians we consider cough as a manifestation of disease; yet, as scientists, we think of cough as a product of physiologic mechanisms. These diseases and mechanisms involve the spectrum of adult medical and pediatric disciplines, including otolaryngology, pulmonology and chest physicians, allergy and immunology, gastroenterology, neurology, cardiology, infectious disease, speech and swallowing pathologists, as well as psychiatry. It is particularly timely for this discussion of cough as a true interdisciplinary problem, since we now consider both “macrophysiologic” (interplay of diseases) and “microphysiologic” perspectives (interplay of mechanisms).


The list of diseases that may induce cough is growing, along with an appreciation of the inter-relatedness of these diseases, as described in Fig. 1 . For example, emerging evidence now supports our long-held observation that the upper and lower airway diseases are closely related as an unified airway, and that allergy plays an important role in exacerbating both upper and lower airway disease. There is also a spectrum of both asthmatic and non-asthmatic lower airway inflammatory disease that often has overlapping clinical signs. Asthmatic, allergic, infectious and other irritant and inflammatory processes in the nose and lung similarly have complex and synergistic physiologic relationships.




Fig. 1


Inter-relatedness of clinical disease relating to cough. Multiple mechanisms exist at both the local and systemic levels to account for synergy in exacerbation of disease processes. Note: systemic disease includes congestive heart failure (CHF), hypertension treated with angiotensin converting enzyme inhibitors (ACEi), and cystic fibrosis (CF). Tumor may have a direct effect on nerves triggering cough, particularly all branches of the vagus. It may also result in an indirect cause of cough through a post-obstructive inflammatory/infectious process in the lung or paranasal sinuses. There are a number of mechanisms by which gastroesophageal reflux disease (GERD) may trigger cough, both directly related to gross or microspiration, as well as through neurologic reflex (see text). Aspiration may also occur independent of GERD.

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Related posts:

  1. Cough: A Worldwide Problem
  2. Vocal Cord Dysfunction, Paradoxic Vocal Fold Motion, or Laryngomalacia? Our Understanding Requires an Interdisciplinary Approach
  3. Occupational, Environmental, and Irritant-Induced Cough
  4. Cough in the Pediatric Population

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Apr 1, 2017 | Posted by in OTOLARYNGOLOGY | Comments Off on Cough Specialists Collaborate for an Interdisciplinary Problem

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