The Top 20 Triggers for Irritant-Induced Chronic Cough

Clinical assessment of chronic, refractory cough (CC) requires extensive knowledge of the possible agents that trigger the behavior. For many SLPs, this knowledge develops over many years of clinical practice, with a few triggers encountered far more frequently than others.

Most of us could reasonably hypothesize that reflux, odors, environmental temperature changes, and allergens are the four most frequently reported triggers for CC. While this top four list may include the most recognized triggers, it is problematic as we then limit the consideration of alternate contributing irritants during our assessment or bias our inquiry.

So, What Are the Additional Triggers?

Published in journals and periodicals worldwide, the findings of a recent scoping review resulted in a list of over 214 different agents reported in the literature to trigger CC.¹ From this long list, the following made it into the top 20:

1. Smoking

2. Reflux (esophageal & extraesophageal)

3. Postnasal drip

4. Ambient conditions (e.g., dry air)

5. Inflammation of sinuses

6. Foods

7. Phonation

8. Positional considerations

9. Animal dander

10. Thermal exposure

11. Indoor pollution*

12. Outdoor air pollution*

13. Fumes/odors/perfume/scent/incense*

14. Chemical exposure*

15. Occupational exposure*

16. Farm exposure*

17. Aerosolized agents*

18. Dust*

19. Environmental irritants & allergens*

20. Gas exposure*

Assessment of the ten agents notated with a "*" requires in-depth knowledge of the specific chemical exposures that may trigger CC relative to occupationor environmental exposure in parts of the world where air quality standards differ. The above-mentioned publication offers a clinically useful checklist from which we as clinicians can standardize the assessment process and, in doing so, mitigate bias toward a small, limited group of better-recognized triggers. It is a sincere hope that as additional triggers are recognized and described, clinicians will share them so that this CC trigger checklist can become even more comprehensive over time.

Sandage Handout: CC Triggers

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