Leicester cough clinic

The Leicester Cough Clinic, based at Glenfield Hospital, is one of only three specialist cough clinics in England. 

We provide a wide range of diagnostic tests and treatment for chronic cough and have about 200 patient referrals each year.

Who is involved and how does the clinic work?

The clinic is run by respiratory expert, Professor Chris Brightling who has extensive clinical experience in this area and is involved in active research in the field.

The clinic is supported by ear nose and throat (ENT) surgeons, radiologists, lung function technicians and by a specialist chest physiotherapist with considerable expertise in the area.

Patients referred from outside Leicestershire are generally assessed and investigated in one visit. Typically specialist breathing tests and an assessment of airway inflammation is done on a Monday morning so that the results are available when patients are seen on Monday afternoon. There is inevitably some waiting time but we hope this will be offset by the travel time saved due to getting everything done in one visit. Local patients will be asked to attend for tests and clinic on different days.

What do we know about chronic cough?

A chronic cough is defined as one lasting more than 8 weeks. This is a common and distressing condition. It particularly affects women between the ages of 45 and 55. Many report a persistent dry cough with a sensation of throat irritation, particularly after exposure to changes in temperature or irritant fumes. Talking and laughing can also trigger cough. The problem is caused by a heightened cough reflex.

Common causes include a side effect of blood pressure tablets (ACE inhibitors such as ramipril, lisinopril, captopril and perindropril), asthma, nasal disease and acid refluxing from the stomach to the gullet and throat. However, in up to 40% of patients none of these conditions are present and the cough is unexplained.

We are usually able to help patients with unexplained cough by reassuring them that they do not have a serious underlying lung condition and working with them to develop strategies to control the cough. We have an active research programme looking into the cause of chronic cough and we hope that better treatments will become available in the future. Reassuringly, the longer-term prognosis of all cough syndromes is good.

What tests might be done?

We nearly always need to do further tests assessing cough severity and looking into possible causes. These include simple breathing tests, blood tests, simple questionnaires and x-rays. Other tests, which you may be less familiar with include:

• Tests of airway responsiveness. This test investigates how ‘twitchy’ your airways are by investigating whether inhaling (breathing in) a substance called methacholine causes narrowing of your airways. We assess this by asking you to exhale (breathe out) forcefully into a breathing machine. We can usually detect airway narrowing before you become aware of it and the investigation does not cuase much discomfort. Patients with asthma nearly always develop narrow airways after inhaling methacholine so this is a good test for the presence of asthma.

• Tests of airway inflammation.  We assess this in two ways. First, we ask patients to exhale into a machine that measures the concentration of a gas called nitric oxide. There is more of this gas present in exhaled air from patients with an inflamed airway. Secondly, we examine the cells and chemicals in a sputum sample (mucous from the lungs) to see whether airway inflammation is present and determine its nature. We stimulate sputum production by asking patients to inhale a salty mist.

• Tests of cough frequency. In some patients we assess cough frequency using a computerised sound-based cough detection system. We ask patients to wear a microphone attached to a small recording system for 24 hours. The recordings are analysed by computer so no speech or other sounds are detected.

Links:

Chronic cough information - written for doctors from Patient UK