Everything you didn’t know about chronic cough: ‘It should be treated as a disease’

Maybe, even if you own it, you’ve never heard of it chronic coughThe symptom lasted for more than eight weeks but was not given the attention it deserved because it seemed common or because it was “just a minor symptom of a disease.” However, it always has a specific reason.

In fact, to try to solve this reflection, starting from 2024 The first drug, A medical prescription from a pulmonary specialist is required.

This is good news because people with a cough that lasts longer than eight weeks should Consult your family doctor Conduct a preliminary study for chronic cough, and if symptoms persist despite basic studies, consider the possibility of referral to a pulmonologist to complete the study.

Therefore, clear communication between experts and patients is necessary. Dr. Astrid Crespo, associate physician in the Department of Pulmonology at Santa Cruz Hospital, reported that this action, if taken, would encourage the use of “protocols and referral circuits between professionals,” thereby promoting A multidisciplinary approach is adopted for these patients. .Sant Pau, from Barcelona.

Cough and its prevalence

Cough is a very common symptom many respiratory diseases. A chronic cough is a cough that lasts for more than eight weeks, while the cough characteristic of a cold usually lasts up to four to six weeks. A recent cross-sectional study showed that the prevalence of chronic cough in the Spanish population was 5.5%.

Chronic cough, diagnosis due to exclusion

for him Diagnosis of chronic cough There is no specific diagnostic test. It is done after ruling out different causes through a series of diagnostic tests (diagnosis of exclusion), which must involve different specialists and levels of care.

These tests vary depending on the age of the patient. In young patients, Rule out allergies, rhinitis or asthma As a cause of chronic cough. In elderly patients, it is important to check whether the cough is related to causes such as gastroesophageal reflux or taking antihypertensive drugs (especially ACE inhibitors), which is common.

Other causes of chronic cough may be smokes and other diseases directly related to it, such as chronic obstructive pulmonary disease (COPD), since these diseases, especially chronic bronchitis, can cause coughing.

But the most common cause of chronic cough is post-infectious pathology.An example is Coronavirus, because a subgroup of patients affected by this infection have persistent coronavirus, those who have had a cough for more than eight weeks and therefore develop a chronic cough. This kind of cough after new coronavirus infection is not contagious, but from a serological point of view, the patient has not completely eliminated the virus.

From symptoms to treatable disease

“Cough has a very significant impact on patients’ quality of life and their home environment, but people don’t realize it,” Dr. Crespo emphasized. at the moment, It is unclear how many health resources are being assigned to address this disease.

Is a chronic cough a symptom and when should it be considered a disease?

Traditionally, chronic cough was considered a symptom when should be considered a disease Its management is heterogeneous and must be multidisciplinary and approached from different levels of care.

Currently, there are no specific medications for chronic cough; those that are used have low effectiveness and side effects because they act at the level of the central nervous system.Last 5-10 years specific drugs have been developed Suitable for patients with chronic cough.

Among these new drugs, we must focus on P2X3 receptor antagonistUnlike the existing treatments for chronic cough to date, which are centrally acting and do not target the cough reflex, they act on new peripheral pathways to suppress the cough reflex through a mechanism that inhibits the activation of ATP channels present in peripheral nerves.

The first drug specifically designed to treat chronic cough will be available in 2024.The drug has been approved by the FDA Effectiveness rate exceeds 75% in clinical trials Stages II and III may apply to refractory chronic cough (where the cough persists despite treatment of the underlying chronic disease) and idiopathic chronic cough (where the underlying cause has not been identified after thorough diagnosis).

The new drug may be used in hospitals and can only be prescribed by pulmonologists who specialize in chronic coughs.

Stratification and treatment of chronic cough

There is currently no tool that can Measure the severity of your cough in clinical practice. To this end, in Catalonia, the Catalan Society of Pulmonology (SOCAP) is working on a project to harmonize the stratification criteria for chronic cough so that it can be divided into different levels of severity (mild, moderate and severe).

Dr. Crespo maintains that doctors must evaluate and agree on when patients should be referred to experts on the subject, and Increased interest in this pathologygiving it “its importance” due to its impact on patients’ quality of life.

On the other hand, another algorithm is being studied to unify the criteria for referral to specialists, with the goal of identifying Under what circumstances and when should patients be referred? From primary care (PC) to pulmonologist, and the patient must return from pulmonologist to PC physician.

Likewise, Catalonia is working towards harmonizing standards and involving different specialties in the multidisciplinary management of chronic cough: Gastroenterologists, Allergists and Pulmonologists.

In the research world, people are looking at diseases that appear later in life, as well as chronic coughing disorders that may have appeared 40 years ago.

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