Chronic cough: causes, diagnosis and treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"La toux chronique persiste plus de 8 semaines et n\u00e9cessite un bilan \u00e9tiologique structur\u00e9. RGO rhinorrh\u00e9e post\u00e9rieure asthme triade, IEC toux s\u00e8che, TOUX hypersensibilit\u00e9 syndrome et prise en charge au Qu\u00e9bec.\">\n<meta name=\"keywords\" content=\"toux chronique, toux chronique causes, toux chronique IEC, toux chronique asthme, RGO toux chronique, rhinorrh\u00e9e post\u00e9rieure toux, toux chronique traitement, syndrome toux hypersensibilit\u00e9, toux chronique bilan, toux chronique Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap');\n\n.co-wrap * {\n font-family: 'Poppins', sans-serif;\n box-sizing: border-box;\n}\n.co-wrap {\n max-width: 'Poppins', sans-serif;\n box-sizing: border-box;\n}\n.co-wrap {\n max-width: 1100px;\n margin: 0 auto;\n padding: 30px 0 60px;\n margin-top: 10px;\n}\n.co-label {\n font-family: 'Cinzel', serif;\n font-size: 14px;\n font-weight: bold;\n letter-spacing: 1px;\n text-transform: uppercase;\n color: #4D6577;\n margin-bottom: 14px;\n display: block;\n}\n.co-wrap h1 {\n font-size: 32px;\n font-weight: 500;\n color: #323C52;\n margin: 0 0 22px;\n line-height: 1.2;\n letter-spacing: 0.5px;\n}\n.co-intro {\n font-size: 16px;\n font-weight: 400;\n line-height: 1.75;\n color: #4D6577;\n margin-bottom: 36px;\n padding-bottom: 32px;\n border-bottom: 1px solid rgba(77,101,119,.2);\n}\n.co-wrap h2 {\n font-size: 20px;\n font-weight: 600;\n color: #323C52;\n margin: 32px 0 12px;\n letter-spacing: 0.3px;\n}\n.co-wrap p {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.7;\n margin-bottom: 14px;\n}\n.co-list {\n list-style: none;\n padding: 0;\n margin: 12px 0 24px;\n}\n.co-list li {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n padding: 10px 14px 10px 38px;\n margin-bottom: 8px;\n border-radius: 6px;\n position: relative;\n background: rgba(77,101,119,.06);\n border-left: 3px solid #4D6577;\n}\n.co-list li::before {\n content: \"\u2713\";\n position: absolute;\n left: 12px;\n font-weight: 700;\n color: #4D6577;\n}\n.co-table {\n width: 100%;\n border-collapse: collapse;\n margin: 14px 0 22px;\n font-size: 14px;\n border-radius: 8px;\n overflow: hidden;\n}\n.co-table thead tr {\n background: #323C52;\n color: #fff;\n}\n.co-table thead th {\n padding: 11px 16px;\n text-align: left;\n font-weight: 600;\n font-size: 13px;\n}\n.co-table tbody tr:nth-child(even) {\n background: rgba(77,101,119,.06);\n}\n.co-table tbody tr:nth-child(odd) {\n background: #fff;\n}\n.co-table td {\n padding: 10px 16px;\n color: #4D6577;\n border-bottom: 1px solid rgba(77,101,119,.12);\n font-size: 14px;\n vertical-align: top;\n}\n.co-table td:first-child {\n font-weight: 600;\n color: #323C52;\n}\n.co-infobox {\n display: flex;\n gap: 12px;\n background: rgba(77,101,119,.06);\n border-radius: 8px;\n border-left: 4px solid #4D6577;\n padding: 14px 18px;\n margin: 18px 0 28px;\n font-size: 14px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.65;\n}\n.co-infobox .ico {\n font-size: 18px;\n flex-shrink: 0;\n}\n.co-urgence {\n background: #fff8f8;\n border-left: 5px solid #c0392b;\n border-radius: 6px;\n padding: 20px 26px;\n margin: 24px 0 32px;\n}\n.co-urgence .co-urgence-titre {\n font-size: 13px;\n font-weight: 700;\n color: #c0392b;\n letter-spacing: 1.5px;\n text-transform: uppercase;\n margin-bottom: 10px;\n}\n.co-urgence p {\n color: #5a2020;\n font-size: 14px;\n margin: 0 0 10px;\n line-height: 1.7;\n}\n.co-urgence p:last-child {\n margin-bottom: 0;\n}\n.co-disclaimer {\n font-size: 13px;\n color: #8a9aaa;\n font-style: italic;\n border-top: 1px solid rgba(77,101,119,.15);\n padding-top: 24px;\n margin-top: 40px;\n line-height: 1.6;\n}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n\n <span class=\"co-label\">Pneumologie & ORL & M\u00e9decine de famille<\/span>\n <h1>Chronic cough<\/h1>\n\n <div class=\"co-intro\">\n La toux chronique est d\u00e9finie par une toux persistant plus de 8 semaines chez l'adulte (plus de 4 semaines chez l'enfant selon certaines d\u00e9finitions) en l'absence d'infection respiratoire aigu\u00eb \u00e9volutive, et constitue l'un des motifs de consultation les plus fr\u00e9quents en m\u00e9decine de premi\u00e8re ligne \u2014 repr\u00e9sentant 10 \u00e0 40 % des consultations de pneumologie. Bien qu'elle soit le plus souvent b\u00e9nigne et li\u00e9e \u00e0 des causes identifiables et traitables, la toux chronique peut \u00eatre extr\u00eamement invalidante sur le plan physique (insomnie + incontinence urinaire d'effort + vomissements + fractures de c\u00f4tes + syncopes) et social (isolement + honte + impact professionnel). Depuis les ann\u00e9es 2020, le concept de syndrome de toux chronique par hypersensibilit\u00e9 (CTHS \u2014 Cough Hypersensitivity Syndrome) est apparu comme cadre physiopathologique unifiant pour les toux chroniques r\u00e9fractaires ou inexpliqu\u00e9es : une sensibilisation des voies aff\u00e9rentes tussig\u00e8nes (nerf vague + r\u00e9cepteurs TRPV1 + P2X3) entra\u00eene un abaissement du seuil de d\u00e9clenchement de la toux en r\u00e9ponse \u00e0 des stimuli habituellement non tussig\u00e8nes (air froid + parler + rire + pression du cou + parfums) \u2014 analogue \u00e0 l'allodynie dans les douleurs neuropathiques. Dans les pays d\u00e9velopp\u00e9s o\u00f9 le tabagisme est contr\u00f4l\u00e9 et la tuberculose rare, les trois grandes causes de toux chronique chez le non-fumeur sans m\u00e9dicament inducteur sont : le syndrome de toux des voies a\u00e9riennes sup\u00e9rieures (SVAST \u2014 anciennement rhinorrh\u00e9e post\u00e9rieure ou PNDS) + l'asthme (dont la variante toux) + et le reflux gastro-\u0153sophagien (RGO) \u2014 la \u00ab triade \u00bb de toux chronique r\u00e9pondant \u00e0 plus de 90 % des cas dans les s\u00e9ries cliniques. La cause la plus fr\u00e9quente de toux chronique est la rhinorrh\u00e9e post\u00e9rieure ou le SVAST, repr\u00e9sentant \u00e0 elle seule 40 \u00e0 50 % des cas. La cause m\u00e9dicamenteuse la plus fr\u00e9quente et la plus importante \u00e0 identifier est la toux induite par les inhibiteurs de l'enzyme de conversion (IEC) \u2014 qui concerne 10 \u00e0 15 % des patients trait\u00e9s par IEC, ind\u00e9pendamment de la dose.\n <\/div>\n\n <h2>Classification par dur\u00e9e<\/h2>\n <ul class=\"co-list\">\n <li><strong>Toux aigu\u00eb (< 3 semaines) :<\/strong> main cause = viral upper airway infection (URTI) + or bacterial pneumonia + or asthma exacerbation + or foreign body (child)<\/li>\n <li><strong>Toux subaigu\u00eb (3\u20138 semaines) :<\/strong> often sequelae of a viral infection (post-infectious cough = most frequent cause) + or whooping cough + or aggravation of an underlying pathology<\/li>\n <li><strong>Toux chronique (> 8 semaines chez l'adulte) :<\/strong> requires a structured etiological work-up according to the usual algorithm<\/li>\n <\/ul>\n\n <h2>Main causes in adult non-smokers<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Cause<\/th>\n <th>Frequency<\/th>\n <th>Clinical clues<\/th>\n <th>Diagnostic test<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>SVAST \/ Rhinorrh\u00e9e post\u00e9rieure (PNDS)<\/td>\n <td>40-50 %<\/td>\n <td>Sensation de mucus s'\u00e9coulant dans la gorge + raclements de gorge r\u00e9p\u00e9t\u00e9s + congestion nasale + rhinite allergique ou vasomotrice + sinusite chronique + toux surtout la nuit et le matin<\/td>\n <td>Examen ORL + fibroscopie nasale + scanner des sinus si sinusite suspect\u00e9e + test th\u00e9rapeutique : antihistaminique + cortico\u00efde nasal \u00d7 4\u20138 semaines<\/td>\n <\/tr>\n <tr>\n <td>Asthma (including cough variant)<\/td>\n <td>25\u201330 %<\/td>\n <td>Toux s\u00e8che paroxystique + souvent nocturne + aggrav\u00e9e \u00e0 l'effort + au froid + aux allerg\u00e8nes + aux AINS + peu ou pas de dyspn\u00e9e dans la variante toux + atopie + tabagisme passif<\/td>\n <td>EFR (spirom\u00e9trie + test de r\u00e9versibilit\u00e9 au bronchodilatateur) + test de provocation \u00e0 la m\u00e9thacholine (si spirom\u00e9trie normale) + FeNO (oxyde nitrique exhal\u00e9 \u2014 \u00e9lev\u00e9 si asthme \u00e9osinophilique) + test th\u00e9rapeutique : CSI \u00d7 4\u20138 semaines<\/td>\n <\/tr>\n <tr>\n <td>Reflux gastro-\u0153sophagien (RGO)<\/td>\n <td>20\u201340 %<\/td>\n <td>Toux s\u00e8che + souvent diurne + aggrav\u00e9e apr\u00e8s les repas + en position allong\u00e9e + sans pyrosis dans 40 % (RGO silencieux) + go\u00fbt acide + enrouement + voix enrou\u00e9e le matin<\/td>\n <td>pH-m\u00e9trie \u0153sophagienne des 24 h (gold standard) + manom\u00e9trie + pH-imp\u00e9dancem\u00e9trie + test th\u00e9rapeutique : IPP double dose \u00d7 8 semaines + modification des habitudes de vie<\/td>\n <\/tr>\n <tr>\n <td>IEC (inhibiteurs de l'enzyme de conversion)<\/td>\n <td>10\u201315 % des patients trait\u00e9s<\/td>\n <td>Toux s\u00e8che + irritative + persistante + d\u00e9butant dans les semaines \u00e0 mois apr\u00e8s l'initiation de l'IEC + non dose-d\u00e9pendante + plus fr\u00e9quente chez les femmes + les Asiatiques + dispara\u00eet en 1\u20134 semaines apr\u00e8s l'arr\u00eat de l'IEC<\/td>\n <td>Relation temporelle avec l'initiation de l'IEC + disparition \u00e0 l'arr\u00eat + r\u00e9apparition \u00e0 la reprise \u2192 diagnostic clinique + substitution par un ARA II (sartans) \u2192 pas de toux<\/td>\n <\/tr>\n <tr>\n <td>Bronchite \u00e0 \u00e9osinophiles non asthmatique (BENA)<\/td>\n <td>10\u201315 %<\/td>\n <td>Toux chronique s\u00e8che sans hyperr\u00e9activit\u00e9 bronchique ni obstruction + \u00e9osinophilie dans les expectorations induites (> 3 %) + r\u00e9ponse aux CSI<\/td>\n <td>Expectorations induites (\u00e9osinophiles > 3 %) + FeNO \u00e9lev\u00e9 + test de m\u00e9thacholine NORMAL (distingue de l'asthme) + test th\u00e9rapeutique : CSI \u00d7 4\u20138 semaines<\/td>\n <\/tr>\n <tr>\n <td>Rare organic causes (< 5 %)<\/td>\n <td>5 %<\/td>\n <td>Cancer bronchique + bronchectasies + fibrose pulmonaire + corps \u00e9tranger + insuffisance cardiaque + diverticule de Zenker + fistule trach\u00e9o-\u0153sophagienne<\/td>\n <td>Chest X-ray + chest CT scan + bronchial fibroscopy<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Red flags \u2014 toux chronique n\u00e9cessitant une investigation urgente<\/h2>\n <ul class=\"co-list\">\n <li><strong>H\u00e9moptysie (sang dans les crachats) :<\/strong> even minimal \u2192 chest CT + bronchial fibroscopy to rule out bronchial cancer or bronchiectasis<\/li>\n <li><strong>Amaigrissement involontaire + sueurs nocturnes + fi\u00e8vre :<\/strong> tuberculosis + cancer + lymphoma<\/li>\n <li><strong>Dyspn\u00e9e progressive :<\/strong> pulmonary fibrosis + heart failure + COPD<\/li>\n <li><strong>Active smoking + > 45 years :<\/strong> high risk of bronchial cancer \u2192 chest x-ray + low-dose CT screening<\/li>\n <li><strong>Apparition apr\u00e8s 50 ans sans cause \u00e9vidente :<\/strong> bronchial cancer + ENT cancer<\/li>\n <li><strong>Stridor + barking cough :<\/strong> laryngeal or tracheal involvement \u2192 fibroscopy + cervicothoracic CT scan<\/li>\n <\/ul>\n\n <h2>Diagnostic algorithm<\/h2>\n <ul class=\"co-list\">\n <li><strong>\u00c9tape 1 \u2014 \u00c9liminer les causes \u00e9videntes et les red flags :<\/strong> systematic chest X-ray + discontinuation of ACE inhibitors if ongoing + smoking cessation if smoker + treatment of COPD or underlying heart failure<\/li>\n <li><strong>\u00c9tape 2 \u2014 Traiter s\u00e9quentiellement les trois grandes causes (approche empirique) :<\/strong> start with posterior rhinorrhea \u2192 if no improvement \u2192 asthma \u2192 if no improvement \u2192 GERD \u2192 each therapeutic trial: 4-8 weeks minimum \u2192 response to treatment is both diagnostic and therapeutic<\/li>\n <li><strong>\u00c9tape 3 \u2014 Si toux persistante malgr\u00e9 les traitements empiriques :<\/strong> pH-metry + manometry + spirometry + methacholine test + FeNO + induced sputum + bronchial fibroscopy + chest CT scan + sinus CT scan<\/li>\n <li><strong>\u00c9tape 4 \u2014 Toux r\u00e9fractaire inexpliqu\u00e9e :<\/strong> chronic hypersensitivity cough syndrome (CTBS) \u2192 neuromodulation treatment (gabapentin + pregabalin + low-dose amitriptyline) + behavioral cough therapy (CTBT)<\/li>\n <\/ul>\n\n <h2>Traitement de la toux chronique par hypersensibilit\u00e9 (CTBS)<\/h2>\n <ul class=\"co-list\">\n <li><strong>Gabapentine (Neurontin\u00ae) :<\/strong> 100-900 mg\/d \u2192 reduced sensitivity of the cough pathways (neuromodulatory mechanism) + significant improvement in randomized trials + side effects: somnolence + dizziness<\/li>\n <li><strong>Pr\u00e9gabaline (Lyrica\u00ae) :<\/strong> identical mechanism + 75-150 mg\/d<\/li>\n <li><strong>Amitriptyline \u00e0 faible dose :<\/strong> 10-25 mg at bedtime \u2192 neuromodulator effect + central antitussive<\/li>\n <li><strong>Gefapixant (Lyfnua\u00ae \u2014 approuv\u00e9 EMA 2022) :<\/strong> selective P2X3 receptor antagonist on cough afferent fibers \u2192 18-30 % reduction in cough frequency \u2192 first drug specifically targeting the pathophysiology of chronic cough \u2192 main side effect: dysgeusia (taste alteration - 70 %) \u2192 not yet approved Health Canada<\/li>\n <li><strong>Th\u00e9rapie comportementale de la toux (CTBT \u2014 Cough Therapy Behavioral Training) :<\/strong> multimodal program (education + cough suppression techniques + breathing + laryngeal hygiene) \u2192 significant reduction in cough frequency \u2192 efficacy comparable to drug therapy + no side effects + recommended alongside drug treatment<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>La toux induite par les IEC (inhibiteurs de l'enzyme de conversion \u2014 ramipril + perindopril + lisinopril + \u00e9nalapril etc.) est la cause m\u00e9dicamenteuse la plus fr\u00e9quente de toux chronique \u2014 touchant 10 \u00e0 15 % des patients trait\u00e9s, plus souvent les femmes et les personnes d'origine asiatique. Elle est non dose-d\u00e9pendante et peut survenir des semaines \u00e0 des mois apr\u00e8s l'initiation du traitement. La substitution par un ARA II (sartans \u2014 valsartan + telmisartan + candesartan) r\u00e9sout la toux sans perte du b\u00e9n\u00e9fice cardiovasculaire. Toujours v\u00e9rifier la liste des m\u00e9dicaments d\u00e8s les premiers pas diagnostiques devant une toux chronique.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Medical consultation recommended<\/div>\n <p>Consulter un m\u00e9decin si une toux persiste plus de 8 semaines sans cause \u00e9vidente + particuli\u00e8rement si elle s'accompagne d'h\u00e9moptysie (sang dans les crachats) + d'amaigrissement + de fi\u00e8vre + ou de dyspn\u00e9e progressive \u2014 ces red flags justifient une radiographie thoracique urgente et une investigation approfondie pour exclure un cancer bronchique ou une tuberculose. Pour le bilan structur\u00e9 de la toux chronique (radiographie + bilan ORL + spirom\u00e9trie + test empirique) et la prescription des traitements cibl\u00e9s, Clinique Omicron offre des consultations m\u00e9dicales dans ses points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins et infirmiers praticiens sp\u00e9cialis\u00e9s (IPS) de Clinique Omicron identifient la cause de la toux chronique selon l'algorithme structur\u00e9 (IEC + tabac + radiographie + triade rhinorrh\u00e9e-asthme-RGO), prescrivent les traitements empiriques s\u00e9quentiels (antihistaminique + cortico\u00efde nasal + CSI + IPP), orientent vers la pneumologie ou l'ORL selon les r\u00e9sultats, substituent les IEC par des ARA II si toux m\u00e9dicamenteuse, et g\u00e8rent les toux r\u00e9fractaires par neuromodulation et th\u00e9rapie comportementale. Des consultations sont disponibles dans plusieurs points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un m\u00e9decin ou d'un pneumologue. Toute toux chronique avec h\u00e9moptysie + amaigrissement + ou chez un fumeur de plus de 45 ans doit b\u00e9n\u00e9ficier d'une radiographie thoracique en urgence pour exclure un cancer bronchique. La toux induite par les IEC dispara\u00eet g\u00e9n\u00e9ralement en 1 \u00e0 4 semaines apr\u00e8s l'arr\u00eat du m\u00e9dicament.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Toux chronique : causes, bilan diagnostique et traitement | Clinique Omicron Pneumologie & ORL & M\u00e9decine de famille Toux chronique La toux chronique est d\u00e9finie par une toux persistant plus de 8 semaines chez l’adulte (plus de 4 semaines chez l’enfant selon certaines d\u00e9finitions) en l’absence d’infection respiratoire aigu\u00eb \u00e9volutive, et constitue l’un des motifs… <a href=\"https:\/\/cliniqueomicron.ca\/en\/toux-chronique\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Chronic cough: causes, diagnosis and treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Toux chronique | Brossard | Clinique Omicron","_metasync_otto_description":"Toux chronique Toux chronique est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0...","_metasync_otto_keywords":"","_metasync_otto_og_title":"","_metasync_otto_og_description":"Toux chronique Toux chronique est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0...","_metasync_otto_twitter_title":"","_metasync_otto_twitter_description":"Toux chronique Toux chronique est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0...","rank_math_title":"","rank_math_description":"","_yoast_wpseo_title":"","_yoast_wpseo_metadesc":"","_aioseo_title":"Toux chronique : causes, bilan diagnostique et traitement | Clinique Omicron","_aioseo_description":"La toux chronique persiste plus de 8 semaines. Triade rhinorrh\u00e9e post\u00e9rieure asthme RGO 90% des cas, IEC toux s\u00e8che 10-15% substituer ARA II, syndrome hypersensibilit\u00e9 gabapentine gefapixant, th\u00e9rapie comportementale au Qu\u00e9bec.","_metasync_seo_title":"","_metasync_seo_desc":"","_metasync_breadcrumb_title":"","_metasync_primary_category":0,"_metasync_primary_product_cat":0,"_metasync_otto_disabled":"","_metasync_hreflang":"","_metasync_plugin_sync_ts":"{\"aioseo\":\"2026-05-04T21:50:56+00:00\"}","_metasync_robots_advanced":"","footnotes":""},"class_list":["post-25019","page","type-page","status-publish","hentry"],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t<meta name=\"description\" content=\"Toux chronique Toux chronique est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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\n\t\t\t\t\t\n\n\n\n\nChronic cough: causes, diagnosis and treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"La toux chronique persiste plus de 8 semaines et n\u00e9cessite un bilan \u00e9tiologique structur\u00e9. RGO rhinorrh\u00e9e post\u00e9rieure asthme triade, IEC toux s\u00e8che, TOUX hypersensibilit\u00e9 syndrome et prise en charge au Qu\u00e9bec.\">\n<meta name=\"keywords\" content=\"toux chronique, toux chronique causes, toux chronique IEC, toux chronique asthme, RGO toux chronique, rhinorrh\u00e9e post\u00e9rieure toux, toux chronique traitement, syndrome toux hypersensibilit\u00e9, toux chronique bilan, toux chronique Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap');\n\n.co-wrap * {\n font-family: 'Poppins', sans-serif;\n box-sizing: border-box;\n}\n.co-wrap {\n max-width: 'Poppins', sans-serif;\n box-sizing: border-box;\n}\n.co-wrap {\n max-width: 1100px;\n margin: 0 auto;\n padding: 30px 0 60px;\n margin-top: 10px;\n}\n.co-label {\n font-family: 'Cinzel', serif;\n font-size: 14px;\n font-weight: bold;\n letter-spacing: 1px;\n text-transform: uppercase;\n color: #4D6577;\n margin-bottom: 14px;\n display: block;\n}\n.co-wrap h1 {\n font-size: 32px;\n font-weight: 500;\n color: #323C52;\n margin: 0 0 22px;\n line-height: 1.2;\n letter-spacing: 0.5px;\n}\n.co-intro {\n font-size: 16px;\n font-weight: 400;\n line-height: 1.75;\n color: #4D6577;\n margin-bottom: 36px;\n padding-bottom: 32px;\n border-bottom: 1px solid rgba(77,101,119,.2);\n}\n.co-wrap h2 {\n font-size: 20px;\n font-weight: 600;\n color: #323C52;\n margin: 32px 0 12px;\n letter-spacing: 0.3px;\n}\n.co-wrap p {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.7;\n margin-bottom: 14px;\n}\n.co-list {\n list-style: none;\n padding: 0;\n margin: 12px 0 24px;\n}\n.co-list li {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n padding: 10px 14px 10px 38px;\n margin-bottom: 8px;\n border-radius: 6px;\n position: relative;\n background: rgba(77,101,119,.06);\n border-left: 3px solid #4D6577;\n}\n.co-list li::before {\n content: \"\u2713\";\n position: absolute;\n left: 12px;\n font-weight: 700;\n color: #4D6577;\n}\n.co-table {\n width: 100%;\n border-collapse: collapse;\n margin: 14px 0 22px;\n font-size: 14px;\n border-radius: 8px;\n overflow: hidden;\n}\n.co-table thead tr {\n background: #323C52;\n color: #fff;\n}\n.co-table thead th {\n padding: 11px 16px;\n text-align: left;\n font-weight: 600;\n font-size: 13px;\n}\n.co-table tbody tr:nth-child(even) {\n background: rgba(77,101,119,.06);\n}\n.co-table tbody tr:nth-child(odd) {\n background: #fff;\n}\n.co-table td {\n padding: 10px 16px;\n color: #4D6577;\n border-bottom: 1px solid rgba(77,101,119,.12);\n font-size: 14px;\n vertical-align: top;\n}\n.co-table td:first-child {\n font-weight: 600;\n color: #323C52;\n}\n.co-infobox {\n display: flex;\n gap: 12px;\n background: rgba(77,101,119,.06);\n border-radius: 8px;\n border-left: 4px solid #4D6577;\n padding: 14px 18px;\n margin: 18px 0 28px;\n font-size: 14px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.65;\n}\n.co-infobox .ico {\n font-size: 18px;\n flex-shrink: 0;\n}\n.co-urgence {\n background: #fff8f8;\n border-left: 5px solid #c0392b;\n border-radius: 6px;\n padding: 20px 26px;\n margin: 24px 0 32px;\n}\n.co-urgence .co-urgence-titre {\n font-size: 13px;\n font-weight: 700;\n color: #c0392b;\n letter-spacing: 1.5px;\n text-transform: uppercase;\n margin-bottom: 10px;\n}\n.co-urgence p {\n color: #5a2020;\n font-size: 14px;\n margin: 0 0 10px;\n line-height: 1.7;\n}\n.co-urgence p:last-child {\n margin-bottom: 0;\n}\n.co-disclaimer {\n font-size: 13px;\n color: #8a9aaa;\n font-style: italic;\n border-top: 1px solid rgba(77,101,119,.15);\n padding-top: 24px;\n margin-top: 40px;\n line-height: 1.6;\n}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n\n <span class=\"co-label\">Pneumologie & ORL & M\u00e9decine de famille<\/span>\n <h1>Chronic cough<\/h1>\n\n <div class=\"co-intro\">\n La toux chronique est d\u00e9finie par une toux persistant plus de 8 semaines chez l'adulte (plus de 4 semaines chez l'enfant selon certaines d\u00e9finitions) en l'absence d'infection respiratoire aigu\u00eb \u00e9volutive, et constitue l'un des motifs de consultation les plus fr\u00e9quents en m\u00e9decine de premi\u00e8re ligne \u2014 repr\u00e9sentant 10 \u00e0 40 % des consultations de pneumologie. Bien qu'elle soit le plus souvent b\u00e9nigne et li\u00e9e \u00e0 des causes identifiables et traitables, la toux chronique peut \u00eatre extr\u00eamement invalidante sur le plan physique (insomnie + incontinence urinaire d'effort + vomissements + fractures de c\u00f4tes + syncopes) et social (isolement + honte + impact professionnel). Depuis les ann\u00e9es 2020, le concept de syndrome de toux chronique par hypersensibilit\u00e9 (CTHS \u2014 Cough Hypersensitivity Syndrome) est apparu comme cadre physiopathologique unifiant pour les toux chroniques r\u00e9fractaires ou inexpliqu\u00e9es : une sensibilisation des voies aff\u00e9rentes tussig\u00e8nes (nerf vague + r\u00e9cepteurs TRPV1 + P2X3) entra\u00eene un abaissement du seuil de d\u00e9clenchement de la toux en r\u00e9ponse \u00e0 des stimuli habituellement non tussig\u00e8nes (air froid + parler + rire + pression du cou + parfums) \u2014 analogue \u00e0 l'allodynie dans les douleurs neuropathiques. Dans les pays d\u00e9velopp\u00e9s o\u00f9 le tabagisme est contr\u00f4l\u00e9 et la tuberculose rare, les trois grandes causes de toux chronique chez le non-fumeur sans m\u00e9dicament inducteur sont : le syndrome de toux des voies a\u00e9riennes sup\u00e9rieures (SVAST \u2014 anciennement rhinorrh\u00e9e post\u00e9rieure ou PNDS) + l'asthme (dont la variante toux) + et le reflux gastro-\u0153sophagien (RGO) \u2014 la \u00ab triade \u00bb de toux chronique r\u00e9pondant \u00e0 plus de 90 % des cas dans les s\u00e9ries cliniques. La cause la plus fr\u00e9quente de toux chronique est la rhinorrh\u00e9e post\u00e9rieure ou le SVAST, repr\u00e9sentant \u00e0 elle seule 40 \u00e0 50 % des cas. La cause m\u00e9dicamenteuse la plus fr\u00e9quente et la plus importante \u00e0 identifier est la toux induite par les inhibiteurs de l'enzyme de conversion (IEC) \u2014 qui concerne 10 \u00e0 15 % des patients trait\u00e9s par IEC, ind\u00e9pendamment de la dose.\n <\/div>\n\n <h2>Classification par dur\u00e9e<\/h2>\n <ul class=\"co-list\">\n <li><strong>Toux aigu\u00eb (< 3 semaines) :<\/strong> main cause = viral upper airway infection (URTI) + or bacterial pneumonia + or asthma exacerbation + or foreign body (child)<\/li>\n <li><strong>Toux subaigu\u00eb (3\u20138 semaines) :<\/strong> often sequelae of a viral infection (post-infectious cough = most frequent cause) + or whooping cough + or aggravation of an underlying pathology<\/li>\n <li><strong>Toux chronique (> 8 semaines chez l'adulte) :<\/strong> requires a structured etiological work-up according to the usual algorithm<\/li>\n <\/ul>\n\n <h2>Main causes in adult non-smokers<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Cause<\/th>\n <th>Frequency<\/th>\n <th>Clinical clues<\/th>\n <th>Diagnostic test<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>SVAST \/ Rhinorrh\u00e9e post\u00e9rieure (PNDS)<\/td>\n <td>40-50 %<\/td>\n <td>Sensation de mucus s'\u00e9coulant dans la gorge + raclements de gorge r\u00e9p\u00e9t\u00e9s + congestion nasale + rhinite allergique ou vasomotrice + sinusite chronique + toux surtout la nuit et le matin<\/td>\n <td>Examen ORL + fibroscopie nasale + scanner des sinus si sinusite suspect\u00e9e + test th\u00e9rapeutique : antihistaminique + cortico\u00efde nasal \u00d7 4\u20138 semaines<\/td>\n <\/tr>\n <tr>\n <td>Asthma (including cough variant)<\/td>\n <td>25\u201330 %<\/td>\n <td>Toux s\u00e8che paroxystique + souvent nocturne + aggrav\u00e9e \u00e0 l'effort + au froid + aux allerg\u00e8nes + aux AINS + peu ou pas de dyspn\u00e9e dans la variante toux + atopie + tabagisme passif<\/td>\n <td>EFR (spirom\u00e9trie + test de r\u00e9versibilit\u00e9 au bronchodilatateur) + test de provocation \u00e0 la m\u00e9thacholine (si spirom\u00e9trie normale) + FeNO (oxyde nitrique exhal\u00e9 \u2014 \u00e9lev\u00e9 si asthme \u00e9osinophilique) + test th\u00e9rapeutique : CSI \u00d7 4\u20138 semaines<\/td>\n <\/tr>\n <tr>\n <td>Reflux gastro-\u0153sophagien (RGO)<\/td>\n <td>20\u201340 %<\/td>\n <td>Toux s\u00e8che + souvent diurne + aggrav\u00e9e apr\u00e8s les repas + en position allong\u00e9e + sans pyrosis dans 40 % (RGO silencieux) + go\u00fbt acide + enrouement + voix enrou\u00e9e le matin<\/td>\n <td>pH-m\u00e9trie \u0153sophagienne des 24 h (gold standard) + manom\u00e9trie + pH-imp\u00e9dancem\u00e9trie + test th\u00e9rapeutique : IPP double dose \u00d7 8 semaines + modification des habitudes de vie<\/td>\n <\/tr>\n <tr>\n <td>IEC (inhibiteurs de l'enzyme de conversion)<\/td>\n <td>10\u201315 % des patients trait\u00e9s<\/td>\n <td>Toux s\u00e8che + irritative + persistante + d\u00e9butant dans les semaines \u00e0 mois apr\u00e8s l'initiation de l'IEC + non dose-d\u00e9pendante + plus fr\u00e9quente chez les femmes + les Asiatiques + dispara\u00eet en 1\u20134 semaines apr\u00e8s l'arr\u00eat de l'IEC<\/td>\n <td>Relation temporelle avec l'initiation de l'IEC + disparition \u00e0 l'arr\u00eat + r\u00e9apparition \u00e0 la reprise \u2192 diagnostic clinique + substitution par un ARA II (sartans) \u2192 pas de toux<\/td>\n <\/tr>\n <tr>\n <td>Bronchite \u00e0 \u00e9osinophiles non asthmatique (BENA)<\/td>\n <td>10\u201315 %<\/td>\n <td>Toux chronique s\u00e8che sans hyperr\u00e9activit\u00e9 bronchique ni obstruction + \u00e9osinophilie dans les expectorations induites (> 3 %) + r\u00e9ponse aux CSI<\/td>\n <td>Expectorations induites (\u00e9osinophiles > 3 %) + FeNO \u00e9lev\u00e9 + test de m\u00e9thacholine NORMAL (distingue de l'asthme) + test th\u00e9rapeutique : CSI \u00d7 4\u20138 semaines<\/td>\n <\/tr>\n <tr>\n <td>Rare organic causes (< 5 %)<\/td>\n <td>5 %<\/td>\n <td>Cancer bronchique + bronchectasies + fibrose pulmonaire + corps \u00e9tranger + insuffisance cardiaque + diverticule de Zenker + fistule trach\u00e9o-\u0153sophagienne<\/td>\n <td>Chest X-ray + chest CT scan + bronchial fibroscopy<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Red flags \u2014 toux chronique n\u00e9cessitant une investigation urgente<\/h2>\n <ul class=\"co-list\">\n <li><strong>H\u00e9moptysie (sang dans les crachats) :<\/strong> even minimal \u2192 chest CT + bronchial fibroscopy to rule out bronchial cancer or bronchiectasis<\/li>\n <li><strong>Amaigrissement involontaire + sueurs nocturnes + fi\u00e8vre :<\/strong> tuberculosis + cancer + lymphoma<\/li>\n <li><strong>Dyspn\u00e9e progressive :<\/strong> pulmonary fibrosis + heart failure + COPD<\/li>\n <li><strong>Active smoking + > 45 years :<\/strong> high risk of bronchial cancer \u2192 chest x-ray + low-dose CT screening<\/li>\n <li><strong>Apparition apr\u00e8s 50 ans sans cause \u00e9vidente :<\/strong> bronchial cancer + ENT cancer<\/li>\n <li><strong>Stridor + barking cough :<\/strong> laryngeal or tracheal involvement \u2192 fibroscopy + cervicothoracic CT scan<\/li>\n <\/ul>\n\n <h2>Diagnostic algorithm<\/h2>\n <ul class=\"co-list\">\n <li><strong>\u00c9tape 1 \u2014 \u00c9liminer les causes \u00e9videntes et les red flags :<\/strong> systematic chest X-ray + discontinuation of ACE inhibitors if ongoing + smoking cessation if smoker + treatment of COPD or underlying heart failure<\/li>\n <li><strong>\u00c9tape 2 \u2014 Traiter s\u00e9quentiellement les trois grandes causes (approche empirique) :<\/strong> start with posterior rhinorrhea \u2192 if no improvement \u2192 asthma \u2192 if no improvement \u2192 GERD \u2192 each therapeutic trial: 4-8 weeks minimum \u2192 response to treatment is both diagnostic and therapeutic<\/li>\n <li><strong>\u00c9tape 3 \u2014 Si toux persistante malgr\u00e9 les traitements empiriques :<\/strong> pH-metry + manometry + spirometry + methacholine test + FeNO + induced sputum + bronchial fibroscopy + chest CT scan + sinus CT scan<\/li>\n <li><strong>\u00c9tape 4 \u2014 Toux r\u00e9fractaire inexpliqu\u00e9e :<\/strong> chronic hypersensitivity cough syndrome (CTBS) \u2192 neuromodulation treatment (gabapentin + pregabalin + low-dose amitriptyline) + behavioral cough therapy (CTBT)<\/li>\n <\/ul>\n\n <h2>Traitement de la toux chronique par hypersensibilit\u00e9 (CTBS)<\/h2>\n <ul class=\"co-list\">\n <li><strong>Gabapentine (Neurontin\u00ae) :<\/strong> 100-900 mg\/d \u2192 reduced sensitivity of the cough pathways (neuromodulatory mechanism) + significant improvement in randomized trials + side effects: somnolence + dizziness<\/li>\n <li><strong>Pr\u00e9gabaline (Lyrica\u00ae) :<\/strong> identical mechanism + 75-150 mg\/d<\/li>\n <li><strong>Amitriptyline \u00e0 faible dose :<\/strong> 10-25 mg at bedtime \u2192 neuromodulator effect + central antitussive<\/li>\n <li><strong>Gefapixant (Lyfnua\u00ae \u2014 approuv\u00e9 EMA 2022) :<\/strong> selective P2X3 receptor antagonist on cough afferent fibers \u2192 18-30 % reduction in cough frequency \u2192 first drug specifically targeting the pathophysiology of chronic cough \u2192 main side effect: dysgeusia (taste alteration - 70 %) \u2192 not yet approved Health Canada<\/li>\n <li><strong>Th\u00e9rapie comportementale de la toux (CTBT \u2014 Cough Therapy Behavioral Training) :<\/strong> multimodal program (education + cough suppression techniques + breathing + laryngeal hygiene) \u2192 significant reduction in cough frequency \u2192 efficacy comparable to drug therapy + no side effects + recommended alongside drug treatment<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>La toux induite par les IEC (inhibiteurs de l'enzyme de conversion \u2014 ramipril + perindopril + lisinopril + \u00e9nalapril etc.) est la cause m\u00e9dicamenteuse la plus fr\u00e9quente de toux chronique \u2014 touchant 10 \u00e0 15 % des patients trait\u00e9s, plus souvent les femmes et les personnes d'origine asiatique. Elle est non dose-d\u00e9pendante et peut survenir des semaines \u00e0 des mois apr\u00e8s l'initiation du traitement. La substitution par un ARA II (sartans \u2014 valsartan + telmisartan + candesartan) r\u00e9sout la toux sans perte du b\u00e9n\u00e9fice cardiovasculaire. Toujours v\u00e9rifier la liste des m\u00e9dicaments d\u00e8s les premiers pas diagnostiques devant une toux chronique.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Medical consultation recommended<\/div>\n <p>Consulter un m\u00e9decin si une toux persiste plus de 8 semaines sans cause \u00e9vidente + particuli\u00e8rement si elle s'accompagne d'h\u00e9moptysie (sang dans les crachats) + d'amaigrissement + de fi\u00e8vre + ou de dyspn\u00e9e progressive \u2014 ces red flags justifient une radiographie thoracique urgente et une investigation approfondie pour exclure un cancer bronchique ou une tuberculose. Pour le bilan structur\u00e9 de la toux chronique (radiographie + bilan ORL + spirom\u00e9trie + test empirique) et la prescription des traitements cibl\u00e9s, Clinique Omicron offre des consultations m\u00e9dicales dans ses points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins et infirmiers praticiens sp\u00e9cialis\u00e9s (IPS) de Clinique Omicron identifient la cause de la toux chronique selon l'algorithme structur\u00e9 (IEC + tabac + radiographie + triade rhinorrh\u00e9e-asthme-RGO), prescrivent les traitements empiriques s\u00e9quentiels (antihistaminique + cortico\u00efde nasal + CSI + IPP), orientent vers la pneumologie ou l'ORL selon les r\u00e9sultats, substituent les IEC par des ARA II si toux m\u00e9dicamenteuse, et g\u00e8rent les toux r\u00e9fractaires par neuromodulation et th\u00e9rapie comportementale. Des consultations sont disponibles dans plusieurs points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un m\u00e9decin ou d'un pneumologue. Toute toux chronique avec h\u00e9moptysie + amaigrissement + ou chez un fumeur de plus de 45 ans doit b\u00e9n\u00e9ficier d'une radiographie thoracique en urgence pour exclure un cancer bronchique. La toux induite par les IEC dispara\u00eet g\u00e9n\u00e9ralement en 1 \u00e0 4 semaines apr\u00e8s l'arr\u00eat du m\u00e9dicament.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Toux chronique : causes, bilan diagnostique et traitement | Clinique Omicron Pneumologie & ORL & M\u00e9decine de famille Toux chronique La toux chronique est d\u00e9finie par une toux persistant plus de 8 semaines chez l’adulte (plus de 4 semaines chez l’enfant selon certaines d\u00e9finitions) en l’absence d’infection respiratoire aigu\u00eb \u00e9volutive, et constitue l’un des motifs… <a href=\"https:\/\/cliniqueomicron.ca\/en\/toux-chronique\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Chronic cough: causes, diagnosis and treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Toux chronique | Brossard | Clinique Omicron","_metasync_otto_description":"Toux chronique Toux chronique est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0...","_metasync_otto_keywords":"","_metasync_otto_og_title":"","_metasync_otto_og_description":"Toux chronique Toux chronique est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0...","_metasync_otto_twitter_title":"","_metasync_otto_twitter_description":"Toux chronique Toux chronique est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0...","rank_math_title":"","rank_math_description":"","_yoast_wpseo_title":"","_yoast_wpseo_metadesc":"","_aioseo_title":"Toux chronique : causes, bilan diagnostique et traitement | Clinique Omicron","_aioseo_description":"La toux chronique persiste plus de 8 semaines. Triade rhinorrh\u00e9e post\u00e9rieure asthme RGO 90% des cas, IEC toux s\u00e8che 10-15% substituer ARA II, syndrome hypersensibilit\u00e9 gabapentine gefapixant, th\u00e9rapie comportementale au Qu\u00e9bec.","_metasync_seo_title":"","_metasync_seo_desc":"","_metasync_breadcrumb_title":"","_metasync_primary_category":0,"_metasync_primary_product_cat":0,"_metasync_otto_disabled":"","_metasync_hreflang":"","_metasync_plugin_sync_ts":"{\"aioseo\":\"2026-05-04T21:50:56+00:00\"}","_metasync_robots_advanced":"","footnotes":""},"class_list":["post-25019","page","type-page","status-publish","hentry"],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t<meta name=\"description\" content=\"Toux chronique Toux chronique est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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