COUGH REVISITED
Chronic persistent cough is one of the most common
complaints of our patients. Many of these patients have suffered
with this symptom for years, especially if they have been
diagnosed with COPD. Chronic cough is a symptom which defines
chronic bronchitis which, in turn, is a common associated illness
with COPD. However, many issues may confuse our adequate
understanding of chronic cough in COPD. These limitations are
evident when it is falsely assumed that chronic cough can only be
related to COPD and does not warrant any further investigation.
The cost of these false assumptions is a lost opportunity to
provide better treatment, and the possibility of a missed
diagnosis.
Even if a patient has COPD, it is incorrect to assume that a
chronic cough which is affecting his or her quality of life can only
be explained by their lung disease. The diagnosis of chronic
bronchitis is made from a history of mucous- producing cough
occurring for 3 months a year for two consecutive years. Many
times the cough presented by COPD patients does not meet this
definition and other causes need to be explored.
The work-up for chronic cough does consist of a number of
investigations which could include additional x-rays or CT scans,
specialized breathing tests and, in some cases, empiric therapy
based on the symptom complex. Most of our COPD patients have
been smokers and an occult malignancy must be considered.
Investigating the cause for a chronic cough is worth the effort.
