An empiric approach to the management of cough: ACCP evidence-based clinical practice guidelines

the Robert Wood Johnson School of Medicine at Camden, Suite 312, 3 Cooper Plaza, Camden, NJ 08103, USA.
Chest (Impact Factor: 7.48). 02/2006; 129(1 Suppl):222S-231S. DOI: 10.1378/chest.129.1_suppl.222S
Source: PubMed


Review the literature to provide a comprehensive approach, including algorithms for the clinician to follow in evaluating and treating the patient with acute, subacute, and chronic cough.
We searched MEDLINE (through May 2004) for studies published in the English language since 1980 on human subjects using the medical subject heading terms "cough," "treatment of cough," and "empiric treatment of cough." We selected case series and prospective descriptive clinical trials. We also obtained any references from these studies that were pertinent to the topic.
The relative frequency of the disorders (alone and in combination) that can cause cough as well as the sensitivity and specificity of many but not all diagnostic tests in predicting the cause of cough are known. An effective approach to successfully manage chronic cough is to sequentially evaluate and treat for the common causes of cough using a combination of selected diagnostic tests and empiric therapy. Sequential and additive therapy is often crucial because more than one cause of cough is frequently present.
Algorithms that provide a "road map" that the clinician can follow are useful and are presented for acute, subacute, and chronic cough.

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    • "That is, not all patients with AHR could be diagnosed as asthma. A study has revealed that only 60~88% of chronic cough patients with positive bronchial provocation were responsive to anti-asthma therapy [22]. Other research showed, 33~74% of allergic rhinitis patients without cough or asthma presented AHR [23] [24]. "
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    ABSTRACT: To investigate the characteristics of gastroesophageal reflux induced cough (GERC) with airway hyperresponsiveness (AHR). Compared to patients with GERC alone and healthy subjects, cough sensitivity, multi-channel intraluminal impedance combined with pH monitoring and airway inflammation were evaluated in patients with GERC and AHR. 23 patients were definitely diagnosed as acid reflux induced GERC, 9 patients developed AHR concomitantly. When compared with GERC patients, patients with AHR had significantly increased number of proximal extent episodes (21.5 (28.6) vs. 7.5 (1.8), Z = -2.038, P = 0.042) and increased proportion of proximal extent episodes to total refluxes episodes (24.5 (13.5)% vs. 4.2 (7.3)%, Z = -2.138, P = 0.032), and the level of IL-8 in the airway of these patients was significantly higher than that in healthy subjects (71.1 (64.0) vs. 24.3 (35.2) pg/ml, Z = -2.013, P = 0.044). Gastroesophageal reflux may cause neutrophilic airway inflammation due to the acid reflux into the airway, which results in AHR. However, AHR is not definitely able to cause chronic cough. Thus differential diagnosis is required in clinical practice.
    International Journal of Clinical and Experimental Medicine 04/2014; 7(3):728-35. · 1.28 Impact Factor
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    • "Chronic cough is an important health-care problem in both primary care and subspecialty clinics [1]. The 2006 ACCP guidelines emphasize the need to aggressively address the etiologies of gastro-esophageal reflux disease (GERD), upper airway cough syndrome (UACS) and cough-variant asthma (CVA) while treating patients with chronic cough [2]. Despite undertaking prolonged courses of therapies directed at GERD, UACS and CVA, a significant proportion of patients continue to experience persisting cough [3]. "
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    ABSTRACT: Chronic cough patients are rendered therapies for gastro-esophageal reflux (GERD), upper airway cough syndrome (UACS) and cough-variant asthma (CVA) with varying benefit. Idiopathic or unexplained cough has emerged as an important clinical entity in both primary care and subspecialty clinics. Recent evidence points to a link between chronic cough and untreated obstructive sleep apnea (OSA). A prospective observational study was done to evaluate the effect of OSA therapy in patients with chronic cough. Patients enrolled into the study underwent questionnaires to evaluate for GERD, UACS and CVA along with screening questionnaires for OSA and daytime sleepiness. The Leicester cough questionnaire (LCQ) was done at baseline and during serial visits to evaluate cough intensity and was used as the primary outcome measure of the effect of CPAP therapy on chronic cough. Out of 37 patients enrolled into the study, only 28 patients had follow up LCQ scores available and therefore underwent analysis. 22/28 patients were suspected to have OSA based on abnormal STOP-BANG screening questionnaire scores and overnight oximetry abnormalities. Of these 19/28 patients had overnight attended polysomnography with definitive diagnosis of OSA yielding a 68% prevalence of OSA in our chronic cough population. Chronic cough patients treated for OSA tended to be older with a significantly higher BMI than chronic cough patients without OSA. Significant improvement of LCQ scores occurred with CPAP therapy for OSA in chronic cough patients. OSA is significantly prevalent in chronic cough patients. Subjects with chronic cough and OSA tend to be older and obese. Treatment of OSA in chronic cough patients yields significant improvement in their health status.
    Cough 07/2013; 9(1):19. DOI:10.1186/1745-9974-9-19 · 1.26 Impact Factor
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    • "The American College of Chest Physicians recommends an empiric trial of therapy for UACS because improvement or resolution of cough in response to specific treatment is the pivotal factor in confirming the diagnosis of UACS as a cause of cough. That should especially be the case if no specific cause can be elicited from the history and examination [36]. "
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    ABSTRACT: Objectives . Chronic cough is a multifactorial symptom that requires multidisciplinary approach. Over the last years, general practitioners refer increasingly more chronic cough patients directly to the otolaryngologist. The aim of this paper is to highlight the issues in diagnosis and management of chronic cough patients from the otolaryngologist perspective. Design . Literature review. Results . Gastroesophageal reflux and postnasal drip syndrome remain one of the most common causes of chronic cough. Better diagnostic modalities, noninvasive tests, and high technology radiological and endoscopic innovations have made diagnosis of these difficult-to-treat patients relatively easier. Multidisciplinary assessment has also meant that at least some of these cases can be dealt with confidently in one stop clinics. Conclusions . As the number of referrals of chronic cough patients to an Ear Nose Throat Clinic increases, the otolaryngologist plays a pivotal role in managing these difficult cases.
    International Journal of Otolaryngology 04/2012; 2012(5):564852. DOI:10.1155/2012/564852
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