Occupational and Environmental Exposures and Their Role in Chronic Cough

Abstract

To review the mechanisms by which occupational and environmental factors can contribute to chronic cough and to discuss the approach to diagnosis and management of these patients with review of recent publications in this area. An Expert Panel Report from the American College of Chest Physicians in 2016 addressed this topic. Recent publications improve understanding of mechanisms of effects. Inhaled dust, fumes, gases, and vapor can cause an irritant or inflammatory response in upper and lower airways leading to cough. Physico-chemical properties, exposure conditions, and host factors can influence effects. Particles ≤ 5 μm mass mean aerodynamic diameter are more likely to reach and affect the terminal lung units and the sinuses. Type I, type III, and type IV hypersensitivity responses contribute to diseases causing chronic cough. Improved diagnostic and immunologic tests are needed for many causative exposures such as home or work fungal exposures.