Investigation and management of persistent dry cough

Abstract

Intrathoracic extramedullary haematopoiesis (EMH) is a rare entity that is usually asymptomatic. A 44 year old man with alpha-thalassaemia is described who developed dyspnoea and massive left sided haemothorax. The haemoglobin disorder was established by Hgb H staining and haemoglobin electrophoretic studies. The DNA analysis revealed it to be a case of double heterozygous terminal codon mutation with the genotype CS / T . Computed tomographic scanning and magnetic resonance imaging of the thorax showed multiple paravertebral masses which were found by thoracoscopic biopsy to be extramedullary haematopoiesis. Although no additional sclerosing pleurodesis or low dose radiation therapy was given, the lung expanded well and there has been no recurrence of haemothorax to date.

The diagnosis and management of chronic cough

“…Symptoms suggestive of asthma, rhinosinusitis or GOR positively predict these conditions in half of patients presenting to a specialist clinic [15]. Although cough may be the sole presenting symptom in all of these conditions [43,44], this should not discourage a careful history.…”

“…Dual pathology may be present [9,15]. Symptoms suggesting these underlying diagnoses may be absent, but important clues within the history frequently go unrecognised.…”

“…However, the experience of specialist cough clinics is that a very high success rate, in the order of 90%, can be achieved (table 1) [3][4][5][6][7][8][9][10][11][12][13][14][15]. The key to successful management is to establish a diagnosis and to treat the cause of cough.…”

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

“…Historically, a number of approaches have been taken for the diagnosis and management of patients with this complaint, including an anatomical diagnostic protocol [3][4][5][6][7][8][9][10], full investigation for common causes in all patients [11,12], and empirical trials of therapy without initial investigation [13][14][15]. The frequency with which the condition has been diagnosed and successfully treated has varied substantially between these studies.…”

Management Modalities of Chronic Cough in Adults

“…Zaman içinde non-astmatik eozinofilik bronşitin (NAEB) tanım-lanması kronik öksürüğü olan olgularda havayolu inflamasyonunun değerlendirilme gerekliliğini ortaya çıkartmıştır. Anatomik-tanısal modelin değişik varyasyonları birçok araştırmacı tarafından başarı ile kullanılmışsa da bu yaklaşımın yeterince yararlı olmadığını ortaya koyan çalışmalar da mevcuttur [10][11][12][13][14][15][16][17][18]. Bu nedenle klinisyenler arasında ileri araştır-maya rağmen tedaviye yanıt vermeyen olgular olduğu fikri destek görmektedir.…”