Investigation and management of chronic cough using a probability-based algorithm

Abstract

Chronic cough is a common and distressing symptom. A novel algorithm has been developed for the management of chronic cough, in which an assessment of clinical probability of disease determines the need to proceed to investigation.In this study, the performance of this algorithm in clinical practice was prospectively evaluated. A total of 131 consecutively referred patients (86 females) whose principal presenting symptom was a cough of duration .8 weeks were studied. Their age (median (range)) was 60 (16-88) yrs and cough duration 5.9 (0.2-65) yrs.A cause of cough was established in 93% of cases. The most frequent diagnoses were asthma (24% of cases), gastro-oesophageal disease (22%), post-viral cough (8%), bronchiectasis (8%) and interstitial lung disease (8%). Primary pulmonary disease was significantly more likely in patients with a productive cough and in patients with an abnormal chest radiograph. Only a small proportion (,8%) of patients had multiple causes of cough. The probability of treatment started on the basis of a high clinical suspicion of either asthma, gastro-oesophageal disease or rhinitis being successful was 74%. Overall, 26% of the patients were managed successfully without the need for any form of investigation other than chest radiography and spirometry.Use of the algorithm resulted in identification of the cause of cough and successful treatment in the large majority of cases. It is concluded that this protocol has the potential to improve management by providing a structured approach, reducing the number of investigations performed, and minimising unnecessary delays in treatment.

An update and systematic review on drug therapies for the treatment of refractory chronic cough

“…Modifications to the ADP sought to simplify the assessment and management of CC [11,12]. Yu et al [13] evaluated a sequential three-step empirical therapy for CC with an overall success rate of 88%.…”

Tos en otorrinolaringología: Revisión actualizada del enfoque clínico

“…Las mujeres son más propensas a desarrollar tos crónica 7,8 . Este síntoma está habitualmente relacionado a la exposición de tabaco, ya sea pasiva o activamente, tanto en niños como adultos 9,10 .…”

“…La mayoría de las veces la tos crónica se explica por una sola causa 8,11,12 . Luego del enfrentamiento diagnóstico adecuado, es posible establecer la etiología en el 93% a 98% de los pacientes 8,13 .…”

“…Luego del enfrentamiento diagnóstico adecuado, es posible establecer la etiología en el 93% a 98% de los pacientes 8,13 . Aproximadamente el 20% de los pacientes presenta recurrencia de sus síntomas en un plazo de seguimiento de 3 meses 12 .…”

“…Diversas publicaciones mencionan dentro de las más frecuentes: asma, reflujo gastroesofágico, rinosinusitis y bronquitis crónica, descarga posterior 7,8,11,12,15,16 . Sin embargo, existen múltiples otras causas que deben considerarse en el diagnóstico diferencial, y que el otorrinolaringólogo debe conocer.…”