Date:
Patient:
Reason for Visit:
Evaluation for chronic cough (mentioning somatic and tic cough as possibilities)
Follow-up for chronic cough with suspected somatic or tic cough component
Assessment of treatment response or management strategies
History:
Presenting Illness:
Duration of cough (chronic cough is typically defined as lasting >8 weeks)
Character of cough (wet/productive, dry/unproductive, hacking)
Frequency and severity of cough episodes
Worsening or improvement factors (e.g., stress, anxiety, specific activities)
Presence of associated symptoms (postnasal drip, wheeze, chest pain)
Triggers for tic-like cough (if suspected) – specific situations, emotions, vocalizations
Past medical history of respiratory conditions (e.g., asthma, allergies)
Medications (including over-the-counter cough suppressants)
Social History:
Smoking history (risk factor for chronic cough)
Occupational exposures (dust, allergens)
Physical Exam:
General: Assess vital signs (temperature, blood pressure) and overall health.
ENT: Evaluate ears, nose, and throat for signs of infection, postnasal drip, or vocal cord abnormalities.
Lungs: Listen for wheezing or abnormal breath sounds.
Diagnostic Tests (may be ordered depending on clinical suspicion):
Chest X-ray: May be helpful to rule out pneumonia or other lung abnormalities.
Spirometry: Measures lung function and may identify underlying obstructive lung disease.
Allergy testing: To assess for allergies that could contribute to cough.
Empiric trial of cough suppressants: May be helpful for differentiating cough variants (somatic cough less likely to respond).
Assessment:
Clinical suspicion of chronic cough: Based on history and physical exam findings.
Possible cough variants:
Somatic cough – cough triggered by non-respiratory factors like stress, anxiety, or habit.
Tic cough – sudden, repetitive cough with involuntary components, often triggered by specific situations or emotions.
Other causes of chronic cough (e.g., postnasal drip, asthma) should also be considered and potentially ruled out.
Plan:
Treatment approach depends on the suspected cough variant:
Somatic cough:
Cognitive behavioral therapy (CBT): First-line treatment for addressing underlying stress or anxiety contributing to the cough.
Relaxation techniques: May help manage stress and reduce cough frequency.
Habit reversal training: Techniques to identify and break the cough habit.
Tic cough:
Habit reversal training: Can be helpful for managing involuntary tic-like components.
Low-dose medication trials: Off-label use of medications like gabapentin or levodopa may be considered in some cases.
Addressing other potential contributors: If allergies or postnasal drip are suspected, medications or therapies specific to those conditions may be recommended.
Follow-up:
Regular follow-up appointments to monitor cough response to treatment and adjust strategies as needed.
Consider referral to a speech-language pathologist for specialized therapy (especially for tic cough).
Patient education: Provide information about the suspected cough variant, treatment options, and potential benefits.
Explain the non-respiratory nature of somatic cough and the importance of non-medicinal approaches.
Emphasize the effectiveness of learning self-management techniques.
Encourage open communication about challenges and progress.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of chronic cough