Assessment: Cognition ; Chronic cough

Cough is one of the most common complaints seen at the outpatient primary health clinic. While the most common aetiologies of chronic cough are asthma, chronic obstructive pulmonary disease, postnasal drip, gastroesophageal reflux disease, drug-induced, and tuberculosis, we often overlook that chronic cough, especially in a young female, can be the initial presenting complaint of an autoimmune disease. In this case report, we present a case of 35-year-old woman with no known prior medical illness who presented with chronic cough for 1 year with no other symptoms initially; but later in the disease course, the patient complained of multiple, symmetrical small joint pain, which led us to the diagnosis of seronegative rheumatoid arthritis.
Lung Diseases, Interstitial ; Chronic Cough

Child ; Chronic Disease ; Cough ; diagnosis ; Humans

Chronic Disease ; Cough ; diagnosis ; etiology ; therapy ; Humans

Chronic cough is a multi-factorial symptom,postnasal drip syndrome (PNDS) and gastro-esophageal reflux disease (GERD) are common causes of chronic cough, which is closely associated with the otolaryngologist. The aim of this paper is to highlight the issues in clinical features, diagnosis and management of chronic cough from the otolaryngologist perspective.
Chronic Disease ; Cough ; diagnosis ; therapy ; Humans

BACKGROUNDThe current diagnostic algorithms for chronic cough require the establishment of the primary presumptive causes followed by the confirmation of diagnosis with the specific therapies. The aim of the study was to investigate the discrepancy between presumptive and definite causes and its clinical implication.

METHODSA total of 109 patients with chronic cough underwent laboratory investigations to identify the cause of cough; including sinus computerized tomography (if needed), histamine bronchial provocation, induced sputum cytology and 24-hour esophageal pH or multi-channel intraluminal impedance combined with pH monitoring. The presumptive causes were confirmed by treating them sequentially. The difference between presumptive and definite causes of chronic cough was compared.

RESULTSSingle cause was more frequent in the definite diagnosis than in the presumptive diagnosis (78.9% vs. 54.1%, χ(2) = 15.01, P = 0.0001). In contrast, multiple causes were significantly fewer in definite diagnosis than in the presumptive diagnosis (15.6% vs. 37.6%, χ(2) = 13.53, P = 0.0002). There was a discrepancy between definite and presumptive causes in 30 patients (27.5%). Compared with the presumptive causes, definite upper airway cough syndrome (24.8% vs. 11.9%, χ(2) = 6.0, P = 0.01) and gastroesophageal reflux disease (6.4% vs. 0, χ(2) = 7.23, P = 0.007) was more frequent as a single cause of chronic cough while cough variant asthma plus gastroesophageal reflux disease (3.7% vs. 11.9%, χ(2) = 5.17, P = 0.02) and upper airway cough syndrome plus nonasthmatic eosinophilic bronchitis (0 vs. 9.2%, χ(2) = 10.48, P = 0.001) were fewer as multiple causes of chronic cough.

CONCLUSIONSA discrepancy was common between presumptive and definite causes of chronic cough. To treat presumptive causes sequentially may be a suitable solution for avoidance of erroneous multiple causes and possible over-treatment.

OBJECTIVETo analyze the etiological diagnosis and efficacy of specific therapy of chronic cough.

METHODSTotally 106 patients with chronic cough were diagnosed using a diagnostic protocol based on the Guideline on Diagnosis and Treatment of Chronic Cough established by China Medical Association, which included history inquiry, physical examination, pulmonary function tests, X-ray or CT of paranasal sinuses or chest, 24-hour esophageal pH monitoring, and sputum cell differentials. The etiological diagnosis was made according to clinical manifestations, examination results, and response to specific therapy.

RESULTSThe cause of chronic cough was confirmed in 101 patients (95.3%). Cough due to a single cause was found in 81 patients (80.2%), and due to multiple causes in 20 patients (19.8%). The causes included cough variant asthma (CVA) in 66 patients (62.3%), postnasal drip syndrome (PNDs) in 15 patients (14.1%), gastroesophageal reflux (GERC) in 11 patients (10.4%), post-infection cough (PIC) in 4 patients (3.8%), angiotensin converting enzyme inhibitor (ACEI) induction in 3 patients (2.8%), and eosinophilic bronchitis (EB) in 2 patients (1.9%). Five patients (4.7%) had not been definitely diagnosed. After specific therapy based on diagnosis, cough disappeared in 92 patients (91.1%) and alleviated in 9 patients (8.9%).

CONCLUSIONSCVA, PNDs, and GERC are the most common causes of chronic cough. Specific therapy based on definite cause can result in good outcome.

Asthma ; diagnosis ; therapy ; Child ; Chronic Disease ; Cough ; diagnosis ; therapy ; Humans

Algorithms ; Child ; Chronic Disease ; Cough ; diagnosis ; therapy ; Guidelines as Topic ; Humans

Child ; China ; epidemiology ; Chronic Disease ; Cough ; diagnosis ; etiology ; therapy ; Humans