Chronic Cough: Hacking Up Better Solutions

PROGRAM DESCRIPTION: Chronic Cough (CC) is an often difficult to treat symptom of an underlying disease process. Its treatment is often approached using empiric medication trials for presumed post viral vagal neuropathy, asthma, allergy or acid reflux in series or tandem. While these approaches can be successful, the medications used may ultimately have been unnecessary, can be costly over time and have side effects that are deleterious. Behaviorally focused adjunct treatments by our speech-language pathology colleagues are often overlooked despite their significant effect for many CC patients. This lecture will provide a background on numerous etiologies of CC but focus on the common causes, with an emphasis on the most common missed etiology of CC, non-acidic reflux disease. The lecture will emphasize what otolaryngologists treating CC can gain from our colleagues in pulmonology, gastroenterology and general/thoracic surgery, as well as the need for, and value of, specific objective testing including imaging, endoscopy, methacholine challenge testing, high resolution esophageal manometry, and hypopharyngeal-esophageal multichannel intraluminal pH-Impedance testing (HEMII-pH). The lecturers, an MD and SLP team who often treat quaternary CC referrals, will discuss the appropriate workup to rule in or out underlying diagnoses, emphasize the role of a multidisciplinary team, and present an organized treatment pathway for the otolaryngologist. A portion of the course will be dedicated to what cough suppression and respiratory retraining therapy can offer CC patients. A more informed approach to CC should result from taking this course.

OUTCOME OBJECTIVE 1: Define the most common reasons for chronic cough and explain why reflux is often not completely ruled out before it is completely worked up.

OUTCOME OBJECTIVE 2: Recognize the important role of behavioral management of Chronic Cough and explain how it complements medical management

OUTCOME OBJECTIVE 3: Explain why acid suppression trials alone for suspected reflux induced cough patients will not always work

BACKGROUND STATEMENT: Chronic Cough (CC) is often treated in a trial-and-error fashion by different specialists. This course will offer a more unifying understanding of the workup and treatment of CC through a joint presentation by a Laryngologist and Speech-Language Pathologist.