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Diagnosing, managing and treating patients with chronic cough – cough that lingers for more than eight weeks – can be challenging. It starts with listening carefully to the patient’s story.
“When you see a patient with chronic cough in your clinic – especially a patient who’s been dealing with this for years without relief – I challenge you at the beginning of the visit to let the patient talk uninterrupted,” says Rachel Taliercio, DO, a physician in Cleveland Clinic’s Respiratory Institute and founder and director of the Chronic Cough Clinic. “Patients often tell me that they feel like no one has ever truly listened to them.”
In a featured episode of Cleveland Clinic’s Respiratory Exchange podcast, Dr. Taliercio shares her expertise on chronic cough. She discusses:
Click the podcast player above to listen to the episode now, or read on for a short edited excerpt. Check out more Respiratory Exchange episodes at my.clevelandclinic.org/podcasts/respiratory-exchange or wherever you get your podcasts.
Podcast host Raed Dweik, MD, MBA: What about medical management of these patients? What are some of the strategies you use to get that chronic cough to improve?
Dr. Rachel Taliercio: It’s very important to use guideline-based therapy. Empiric trials are appropriate if the clinical history suggests. So, if you suspect a component of upper airway cough syndrome, again, the treatment response is days to weeks. You can try a combination of intranasal steroids and second-generation antihistamines.
If you think cough variant asthma is playing a role, even a short course of empiric systemic steroids is appropriate or high-dose inhaled steroids with a long-acting bronchodilator. Similarly, with heartburn, again, if you have a clinical history that supports it, an empiric trial is appropriate. Most of the patients that I see have conditions called refractory chronic cough or unexplained chronic cough. And it’s very important that you this terminology, not only to help patients but when you’re communicating with other providers.