Dr. Roxana Siles discusses the complexity of managing patients with chronic cough

Roxana Siles, MD, FAAAAI, co-director of the Cleveland Clinic Asthma Center, discusses the challenges of managing patients with chronic cough.

Primary care physicians play a key role in the management of patients with chronic cough; however, these patients still face many challenges, some of which include concurrent asthma, acid reflux, and postnasal drainage, noted Roxana Siles, MD, FAAAAI, staff member of the Department of Allergy and Immunology at the Cleveland Clinic and co-director of the Asthma Center at the Cleveland Clinic.


What are the diagnostic challenges of chronic cough?

Cough affects millions of people. I think the biggest challenge is that a lot of times chronic cough is multifactorial; there is no one easy answer. There are different common causes of a cough, but some people have a little of each. When we think of chronic cough, which is defined as coughing for more than 8 weeks, we think of things like acid reflux, postnasal drainage. We also think of asthma. It is not uncommon to find all 3 of these conditions in the same patient. So what part of that puzzle or what part of that pie goes where, and of course we have those patients who have an intractable cough or an unexplained cough that’s even more challenging.

Are patients presenting to primary care with what is eventually diagnosed as a chronic cough generally referred to the correct specialists?

I think primary care plays a key role in the initial management of these patients. They are often very good at trying to focus on the root cause of their symptoms and they do a good job of trying to maximize the symptoms. But it is not uncommon for patients to come to our practice for a more specialized assessment, and this often involves a multi-specialty assessment. Like I said, we think of different conditions, and it’s certainly not uncommon to have ear, nose, and throat doctors. [otorhinolaryngologists]; pulmonologists; and allergists work together. Even speech therapy is a common specialty that we recruit for the care of these patients.

Sharon D. Cole