Uncommon Causes of Cough: ACCP Evidence-Based Clinical Practice Guidelines

Objectives:

• To describe the uncommon causes of cough.

Design/Methodology:

• An English language literature search by MEDLINE citations from 1975 through 2004 was used to identify publications on uncommon pulmonary and nonpulmonary disorders.

Results:

• A substantial number of uncommon or rare disorders were identified. Due to their rarity, it was difficult to develop a meaningful evidence-based guideline for diagnosis and therapy.

Conclusions:

• Cough is a major or presenting symptom in many uncommon disorders. A strong index of suspicion is essential for diagnosis. The diagnosis and management of cough depend on the underlying etiology.

Key Recommendations:

1. Consider uncommon causes when evaluating chronic cough.
2. Do not diagnose unexplained cough until common causes have been ruled out.
3. Perform a CT scan and bronchoscopy if cough persists after common causes are considered.
4. Consider the possibility of an airway foreign body in cases of abrupt onset cough.
5. Evaluate the possibility of drug-induced cough in patients with unexplained cough.
6. Consider withdrawing suspected drugs in patients with unexplained cough.

Uncommon Causes of Cough:

• Pulmonary Disorders: Tracheobronchomalacia, Tracheobronchomegaly (Mounier-Kuhn Syndrome), Tracheobronchopathia Osteochondroplastica, Tracheobronchial Amyloidosis, Airway Foreign Bodies, Broncholithiasis, Lymphangioleiomyomatosis, Pulmonary Langerhans Cell Histiocytosis, Pulmonary Alveolar Proteinosis, Pulmonary Alveolar Microlithiasis.
• Nonpulmonary Disorders: Connective Tissue Disorders (Relapsing Polychondritis, Scleroderma, Rheumatoid Arthritis, Systemic Lupus Erythematosus, Sjogren Syndrome), Vasculitides (Giant Cell Arteritis, Wegener Granulomatosis), Esophageal Disorders (Tracheoesophageal Fistula), Inflammatory Bowel Diseases, Miscellaneous (Drug-induced cough, Post-lung surgery complications, Mediastinal lesions, Vocal cord dysfunction, Ear problems, Pulmonary edema, Pulmonary embolism, High altitude exposure, Tourette syndrome, High cervical ossification of the ligamentum flavum).