The Allergist Episode 49 – Finding the Fix for Chronic Cough

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“At least 60% [of clinic patients] don’t respond to anything, or have been to somebody else before they’ve come to me and they’ve tried everything and failed.”

– Dr. Imran Satia

Dr. Imran Satia, Respirologist and Associate Professor at McMaster University and Canada Research Chair in Chronic Cough, joins Dr. Mariam Hanna to walk clinicians through a practical, evidence-based approach to diagnosing and managing chronic cough. With decades of research and clinical experience, Dr. Satia explains how to define chronic cough and its subtypes, recognize red flags, and navigate the common — and less common — causes that keep patients coughing for years.

On this episode, you’ll hear:

  • The difference between chronic cough, refractory chronic cough, and unexplained chronic cough — and why the terminology matters for treatment.
  • The key investigations every patient with chronic cough should have, and how to interpret results in the context of cough hypersensitivity.
  • The role and real-world value of methacholine challenge, FeNO, induced sputum, and sputum culture in refining diagnosis and guiding therapy.
  • Why empiric ICS–LABA and PPI trials aren’t always the right move — and when they are.
  • Management strategies for patients who don’t respond to initial treatment, starting with a low-dose morphine trial, followed by neuromodulators, speech therapy, and clinical trial options.

By the end of the episode, you’ll have a clear, step-by-step framework for assessing chronic cough, avoiding unnecessary treatments, and helping even the most refractory patients find relief.

Posted on August 19, 2025.