Assessment: Cognition ; 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

BACKGROUND: Chronic cough after pulmonary resection is one of the most common complications, which seriously affects the quality of life of patients after surgery. Therefore, the aim of this study is to explore the risk factors of chronic cough after pulmonary resection and construct a prediction model. METHODS: The clinical data and postoperative cough of 499 patients who underwent pneumonectomy or pulmonary resection in The First Affiliated Hospital of University of Science and Technology of China from January 2021 to June 2023 were retrospectively analyzed. The patients were randomly divided into training set (n=348) and validation set (n=151) according to the principle of 7:3 randomization. According to whether the patients in the training set had chronic cough after surgery, they were divided into cough group and non-cough group. The Mandarin Chinese version of Leicester cough questionnare (LCQ-MC) was used to assess the severity of cough and its impact on patients' quality of life before and after surgery. The visual analog scale (VAS) and the self-designed numerical rating scale (NRS) were used to evaluate the postoperative chronic cough. Univariate and multivariate Logistic regression analysis were used to analyze the independent risk factors and construct a model. Receiver operator characteristic (ROC) curve was used to evaluate the discrimination of the model, and calibration curve was used to evaluate the consistency of the model. The clinical application value of the model was evaluated by decision curve analysis (DCA). RESULTS: Multivariate Logistic analysis screened out that preoperative forced expiratory volume in the first second/forced vital capacity (FEV1/FVC), surgical procedure, upper mediastinal lymph node dissection, subcarinal lymph node dissection, and postoperative closed thoracic drainage time were independent risk factors for postoperative chronic cough. Based on the results of multivariate analysis, a Nomogram prediction model was constructed. The area under the ROC curve was 0.954 (95%CI: 0.930-0.978), and the cut-off value corresponding to the maximum Youden index was 0.171, with a sensitivity of 94.7% and a specificity of 86.6%. With a Bootstrap sample of 1000 times, the predicted risk of chronic cough after pulmonary resection by the calibration curve was highly consistent with the actual risk. DCA showed that when the preprobability of the prediction model probability was between 0.1 and 0.9, patients showed a positive net benefit. CONCLUSIONS Chronic cough after pulmonary resection seriously affects the quality of life of patients. The visual presentation form of the Nomogram is helpful to accurately predict chronic cough after pulmonary resection and provide support for clinical decision-making.
Humans ; Chronic Cough ; Cough/etiology* ; Lung Neoplasms ; Pneumonectomy/adverse effects* ; Quality of Life ; Retrospective Studies

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

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

Child ; Chronic Disease ; Cough ; diagnosis ; Humans ; Practice Guidelines as Topic

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.