Monday, 2 May 2016
Viral Cough - self limiting. No anti-tussive therapy needed. Efficacy of OTC medications is not compelling. Home based remedies like honey and lemon or honey and coffee.
Lasts >8 weeks. Mostly women, with an average age of 55. Can treat empirically before investigations.
Pulmonary fibrosis - get honeycomb on the CT. Make sure you treat any concurrent reflux,
Reflux - if asymptomatic don't treat. Otherwise, PPI BD + ranitidine. Next step pro-kinetics like metoclopramide.
Latanoprost - augments cough-reflex sensitivity
ACE inhibitors - may take up to several months to stop. ACE inhibitors upregulate the cough reflex
Bleomycin, methotrexate and amiodarone may cause pulmonary fibrosis
- if >40 and has ever smoked and has cough, fatigue, SOB, chest pain, weight or appetetite loss.
- if >40 and persistent or recurrent chest infection, clubbing, specific lymphadenopathy, chest signs consistent with lung cancer, thrombocytosis.
Consider checking for sleep apnoea - CPAP may help
Treat cause - first generation antihistamines can help.
If cold related consider brompheniramine and SR pseudoephedrine. Naproxen can also help.