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Dr Roxana Siles Discusses the Complexity of Managing Patients With Chronic Cough


Roxana Siles, MD, FAAAAI, codirector of the Asthma Center at Cleveland Clinic, discusses the challenges of managing patients with chronic cough.

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


What are the diagnosis challenges for chronic cough?

Cough affects millions of people. I think the biggest challenge is that a lot of times, chronic cough is multifactorial; there is not just 1 easy answer. There are different common causes for cough, but some people have a bit of each one of them. When we think of chronic cough, which is defined by cough that is more than 8 weeks, we think of things like acid reflux, postnasal drainage. We also think about asthma. It’s not uncommon to find all those 3 conditions in the same patient. So how much of that puzzle or how much of that pie goes to where, and then of course, we have those patients who have refractory cough or unexplained cough that are even more challenging.

Are patients who present to primary care with what is ultimately diagnosed as chronic cough typically referred to the right specialists?

I think primary care plays a key role in first managing these patients. They are often very good at trying to hone in on the primary cause of their symptoms, and they do a good job at trying to maximize symptoms. But it’s not uncommon when we do see patients come to our office for more specialized evaluation, and it does often entail a multispecialty evaluation. As I said, there are different conditions that we think of, and certainly it’s not uncommon to have ear, nose, and throat doctors [otorhinolaryngologists]; pulmonologists; and allergists work together. Even speech pathology as well is a common specialty that we recruit for management of these patients.

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