![]() The onset of asthma has been linked to its use. The persistence of a cough after the withdrawal of ACEIs raises the possibility of other causes of a cough. In the case of ACEI therapy, stop the therapy, improvement occurs within four weeks. ![]() A cough should improve within eight weeks of smoking cessation. Patients who have isolated chronic nocturnal cough, with a normal physical examination, chest x-ray, and spirogram, are unlikely to have serious pulmonary conditions.Įncourage smokers to cease smoking. HRCT–when no other diagnosis can be made. Twenty-four-hour ambulatory oesophageal pH or oesophageal manometry for diagnosing GERD. Bronchoscopy is also indicated whenever there are abnormal chest x-ray, hemoptysis, obstructive lesions, and infiltrates, that otherwise elude diagnosis. Bronchoscopy should be performed after excluding all common causes if foreign body inhalation is suspected. īronchial provocation testing with methacholine or histamine is positive in bronchial asthma. Induced sputum analysis when sputum is not easily available, and it is mandatory to examine the sputum. Possible further investigations include: Bordetella pertussis can be detected from the nasopharyngeal secretions. Cold agglutinin titer for mycoplasma pneumoniae, in suspected cases. ESR and CRP may give a clue to the presence of infection, malignancy, and connective tissue disorders. A cytological examination is to identify malignant cells and to rule out eosinophilic bronchitis. When feasible and in case of doubt, mycobacterial culture is also necessary. Bacterial culture is needed if the sputum is purulent. Sputum examination is essential, whenever possible. Diseases causing chronic cough but missed on chest x-ray include tumors, early ILD, bronchiectasis, and atypical mycobacterial pulmonary infection. A chronic cough with a normal chest x-ray occurs with ACE inhibitor therapy, postnasal drip, GERD, and asthma.
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