Persistent Dry Cough: Causes and Solutions - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Miss Star: Based on your symptoms, it is likely not a bacterial infection but rather an allergic cause.
Here is some information for your reference:
┌─── 　■ Yeh Da-Wei ENT Clinic Medical Education ■　 ───
2000/01/24
The leading dizziness physician in the Zhukiao area, a pioneer in online medical practice in Taiwan
└─　Yeh Da-Wei ENT Clinic website: http://www.csie.nctu.edu.tw/~yehdawei
┘E-mail: [email protected]
Tel: 03-5227372
Address: No.
89, Dongmen St., Hsinchu City
This article will be organized later on the 【 Yeh Da-Wei ENT Clinic website / Health Education 】.
Articles on this website are welcome to be cited, but please indicate the source.
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【Fear of leaks when building a house, fear of treating coughs for doctors】
"Buying a president with money"… During this lively presidential election, we have learned a few colorful Taiwanese idioms.
Today, this article will discuss one of the most troublesome issues for practicing physicians: cough.
There’s a vivid saying that reflects the difficulties faced by doctors – "Fear of leaks when building a house, fear of treating coughs for doctors." Coughing patients make up a significant proportion of the daily outpatient visits for family medicine, internal medicine, ENT, and even obstetrics and gynecology.
Besides providing cough suppressants and syrups, let’s discuss some basic concepts related to cough.
◎ Viral Infection – Viral Bronchitis
The reason we cough is due to the presence of "cough receptors" in the throat, trachea, bronchi, sinuses, and ears.
If these areas are stimulated or inflamed, leading to secretions, a cough reflex will occur.
Just like with fever, in addition to administering antipyretics to comfort the patient (or family), it is crucial not to overlook identifying the cause of the symptoms (fever, cough).
Generally speaking, the common cold (caused by rhinoviruses, adenoviruses, respiratory syncytial viruses, parainfluenza viruses, coronaviruses, etc.) primarily presents with nasal symptoms (runny nose, nasal congestion) and rarely causes cough.
Sometimes, cough occurs due to post-nasal drip irritating the "cough receptors." The most common cause of cough is "viral bronchitis." As mentioned, common colds rarely present with cough symptoms; if a cough persists for several days, it should be diagnosed as bronchitis, caused by similar viruses.
The bronchi are part of the respiratory tract, and viral infections do not precisely target only the bronchi.
Therefore, in addition to cough, patients often exhibit conjunctivitis, runny nose, sore throat, hoarseness, fever, or fatigue as systemic symptoms.
◎ Bacterial Infection – Bacterial Bronchitis, Sinusitis
Bacterial bronchitis caused by bacterial infections is less common, but it should not be overlooked as it may delay the use of antibiotics.
For example, during the recent flu outbreak, Hsinchu Provincial Hospital reported multiple cases of cough patients infected with "Mycoplasma." Focusing solely on diagnosing the influenza virus can easily lead to severe pneumonia complications.
The common cold rarely lasts more than a week, while bronchitis or pneumonia can extend to two to three weeks.
If a patient has a persistent cough and high fever, in addition to considering asthma or allergic conditions, it is essential to be vigilant about Mycoplasma infection.
Because this infection often does not present with specific findings during auscultation, X-rays frequently reveal extensive pneumonia or pleural effusion.
The inconsistency between X-ray changes and clinical auscultation often leads to delayed diagnosis by physicians.
Mycoplasma antibodies are a type of cold agglutinin that can show agglutination at low temperatures (4 °C), which can serve as a diagnostic basis.
Mycoplasma lacks a cell wall, so common antibiotics like cephalosporins or penicillin are ineffective; the standard treatment is erythromycin for two weeks.
Another less common cause of bacterial bronchitis is Bordetella pertussis.
Recent reports about antibiotic misuse in the media are related to erythromycin being used to prevent neonatal whooping cough, which has caused pyloric stenosis in infants; this is a separate issue.
◎ Allergic Conditions – Bronchial Allergy (Asthma), Cough Variant Asthma
For a patient who has been coughing for more than two weeks without improvement, it should not be dismissed as just a lingering cold.
At this point, one should be alert to the previously mentioned bacterial infections, lobar collapse (most commonly due to foreign body aspiration), and asthma.
The vast majority of post-cold coughs are caused by asthma, and many children with asthma or sinusitis may only present with cough.
Therefore, when diagnosing the cause of cough, one must not only examine for redness and swelling in the throat (which is not significantly related to cough) but also remember to check the nasal passages and auscultate the chest.
This is to avoid missing a diagnosis of sinusitis that requires timely antibiotic treatment or misdiagnosing asthma as a cold or heart disease.
Asthma symptoms can vary widely, with each patient presenting differently, making it easy to confuse with common diseases across various specialties.
Cough is often attributed to post-nasal drip or unresolved cold; palpitations and chest pain are considered heart disease; shortness of breath when climbing stairs is attributed to obesity or lack of exercise.
Just as ENT specialists are often the first to diagnose HIV patients, they also frequently diagnose asthma.
Patients often visit the clinic for a cold, and if they have a persistent cough along with other allergic symptoms such as runny nose, sneezing, and itchy eyes, one should suspect asthma.
There is also a condition known as cough variant asthma (CVA), where chronic cough is the only symptom, with no history of asthma or difficulty breathing, and normal pulmonary function tests, but the airways are abnormally sensitive, and cough disappears after using bronchodilators.
You may wonder why an ENT specialist discusses asthma; in fact, the current specialization system is often criticized for being overly detailed.
While this allows for more precise diagnoses and treatments for specific diseases, it has also led to peculiar situations where specialists operate independently.
Thus, patients with dizziness who visit ENT clinics are always diagnosed with Meniere's disease.

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Reply Date: 2001/04/01