Management of Tracheal Diverticulitis with Chronic Cough

Initial Conservative Management

Discontinuing ACE inhibitors can resolve cough in patients taking them, with resolution typically occurring within days to 2 weeks (median 26 days), as recommended by the American College of Chest Physicians 1, 2
Counseling smoking cessation is crucial, as 90% of patients with chronic bronchitis will have resolution of cough after quitting, according to the American College of Chest Physicians 3
Initiating a first-generation antihistamine/decongestant combination, such as brompheniramine with sustained-release pseudoephedrine, is the first-line empiric therapy for upper airway cough syndrome (UACS), as suggested by the American College of Chest Physicians 4, 2
Expect response to UACS treatment within 1-2 weeks, though complete resolution may take several weeks, with a moderate strength of evidence 5
Starting inhaled corticosteroids combined with bronchodilators after 2-4 weeks if cough persists is recommended, as asthma is a common etiology of chronic cough, according to the American College of Chest Physicians 4, 5
Initiating proton pump inhibitor therapy with dietary modifications is recommended for gastroesophageal reflux disease (GERD) treatment, with assessment of response over 1-3 months, as suggested by the American College of Chest Physicians 6, 7

Recurrent respiratory infections persisting despite adequate antibiotic therapy may require surgical excision, as recommended by the American College of Chest Physicians 2
Compression of adjacent organs causing significant symptoms, such as recurrent laryngeal nerve paralysis causing dysphonia, may require surgical excision, with a high strength of evidence 1

Systematically evaluating and treating common causes of chronic cough, such as UACS, asthma, and GERD, is crucial, as these frequently coexist and may be the primary drivers of symptoms, according to the American College of Chest Physicians 1, 2
Using sequential and additive therapy is recommended, as multiple conditions often contribute simultaneously to chronic cough, with a moderate strength of evidence 1, 5
First-generation antihistamines are required for UACS treatment, as newer non-sedating antihistamines are ineffective, as recommended by the American College of Chest Physicians 4

Antibiotic response for infected diverticulum typically occurs within days to weeks, although the exact timeline may vary depending on the severity of the infection 5
UACS treatment response typically occurs within 1-2 weeks for initial improvement, with a moderate strength of evidence 5
Asthma treatment response typically occurs within 2-4 weeks, with a moderate strength of evidence 5
GERD treatment response typically occurs within 1-3 months, with a moderate strength of evidence 7
Overall chronic cough resolution may require maintaining all partially effective treatments for several months, as recommended by the American College of Chest Physicians 1