Do you have a persistent cough? If you have been coughing for weeks without improvement, it is essential to know how to do it. diagnosis of chronic cough, what medical tests are used and what experts You can attend. In this article we explain step by step the clinical evaluation process, the warning signs to take into account and how health professionals act to identify its origin and treat it effectively.

How to diagnose chronic cough?

People with chronic cough first they must go to their family doctor, and depending on the accompanying symptoms and signs, you will be referred to another specialist professional.

Before this referral, it is normal to check adherence to treatment (in case of a pre-existing condition) and smoking cessation, if the patient is a smoker.

You will also likely have at least a chest X-ray and spirometry with bronchodilator testing.

Cough assessment

When you see your doctor, the following tests will be performed to evaluate and determine the cause of your cough.

First, a history will be taken to gather all the information related to the cough:

• About its duration and characteristics, triggering factors, and the timing of its onset.

• Symptoms that point to possible causes such as respiratory infection or gastroesophageal reflux will be sought.

• Personal history will be recorded, including recent respiratory infections, allergies, asthma, COPD, gastroesophageal reflux disease, smoking, current medications, and/or chronic exposure to certain irritants or allergens in the environment.

• Information about the patient's profession and environment will also be collected.

The physical examination will assess the presence of fever, the number of breaths per minute, and the presence of secretions in the upper respiratory tract or lungs, along with their characteristics. The color and viscosity of the sputum can help determine a specific diagnosis.

Other tests that could be performed would be:

• Spirometry with a bronchodilator test to rule out lung disease as a cause. To specifically rule out asthma, the FENO (Fractional Exhaled Nitric Oxide) test and methacholine, if necessary, could be used.

• Allergy study

• Electro and/or echocardiogram

• lung ultrasound

• Pulse oximetry to determine the amount of oxygen in the blood

• Chest X-ray and/or CT scan

• digestive endoscopy

• pH-metry and esophageal manometry

• Sputum analysis or bronchial mucosal biopsy to rule out eosinophilic bronchitis or gastroesophageal reflux

Warning signs

In patients with a chronic cough, there are certain symptoms that warrant caution, and when they appear, it would be advisable to see a doctor. These signs and symptoms include:

• Coughing up blood

• Smoker with changes in cough

• Voice disorders

• ronquera

• Disproportionate feeling of suffocation

• Symptoms such as fever, weight loss, edema in extremities with weight gain

• Vomiting

• Swallowing problems

• Recurrent pneumonia

• Abnormal respiratory examination

• Pathological radiograph

• Having been exposed to people with tuberculosis, being infected with HIV, or receiving treatment with corticosteroids or other drugs that suppress the immune system

• Risk factors for HIV infection

Source: White Paper on Chronic Cough

Which specialists should I consult?

People with chronic cough, it is logicalwhat prijust go to your family doctor (Primary Care) and depending on the accompanying symptoms and signs, you will be referred to another professional.

Specialists involved in the diagnosis and treatment of chronic cough:

• Primary care (initial assessment)

• otolaryngologist: en cases of rhinosinusitis, dysphonia, postnasal drip, or vocal cord dysfunction

• Gastroenterologist: if gastroesophageal reflux is suspected

• Cardiologist: when the cause may be related to heart problems or medication for high blood pressure

• Pulmonologist: in cases of suspected asthma, chronic bronchitis, bronchiectasis, pulmonary fibrosis, or cystic fibrosis. It will also aid in the diagnosis of cough reflex hypersensitivity.

• Allergist: in people with allergies

• Oncology: in cases of bronchogenic carcinoma, bronchialveolar carcinoma, airway tumors, or tumors in the mediastinal area

• Occupational medicine: in case of exposure to irritating substances at work

• Smoking Unit: if the person is a smoker of tobacco or any of its derivatives

• Dream Unit: in cases of possible sleep apnea

Author: Eva Maroto

References:

1. Cough in adults (MSD Manual Professional Version).
2. Criteria for referring adult patients with chronic cough between pulmonology and primary care