An empiric integrative approach to the management of cough - ACCP evidence-based clinical practice guidelines
ABSTRACT 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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ABSTRACT: Radiology is one of the important pillars of clinical diagnosis and management. With the advance of science and technology, there are also advances in the field of imaging and lots of imaging modalities have been added into the armamentarium of the radiologist. Unfortunately there is no consensus guideline regarding the appropriateness of ordering of those investigations in a clinical situation. As every good thing comes with its own price tag, radiological investigations also run the risk of radiation (X-ray, DSA and CT scan) or of high cost and availability (MRI). In this chapter, we wish to present a simplified patterned approach of possible radiological investigations by creating hypothetical clinical situations.API Textbook of Medicine, 10th edited by Y P Munjal, 02/2015: chapter Appropriate Ordering of Radiological Investigations: pages 94-111; Jaypee Brothers.
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ABSTRACT: Patients presenting with chronic cough pose a common diagnostic dilemma during routine consultations at public primary care clinics in Malaysia. To date, there has been little attempt at designing a standardized model or algorithm to facilitate an accurate diagnosis of chronic cough. This study proposes a clinical method to detect the causes of chronic cough in a primary care setting in Malaysia. Materials and Methods: A total of 117 patients aged above 18 at an urban primary care clinic were tracked over a span of 5 months to diagnose the cause of chronic cough. A therapeutic‑diagnostic method was employed to help identify the causes of chronic cough. Subsequently, the demographic details of patients, the prevalence of the different causes of chronic cough and the relationship between history and diagnosis were analyzed statistically. Results: Chronic cough had a slightly higher male preponderance (51.3% vs. 48.7%). Patients within the ‘above 60’ age category had the highest frequency of chronic cough. The most common cause of chronic cough was post‑infectious cough (n = 42, 35.9%), followed closely by angiotensin‑converting enzyme‑inhibitor related cough (n = 14, 12%). Majority of patients had the symptom of phlegm production (n = 41, 54%). 33 patients (29.2%) had recent upper respiratory tract infection (<2 weeks ago) prior to the diagnosis of chronic cough. There were poor association between symptoms and the various entities comprising chronic cough. The exceptions were the following associations: (1) Bronchial asthma and itchiness of throat (P = 0021), (2) gastroesophageal reflux disease and heartburn (P < 0.001), (3) upper airway cough syndrome and running nose (P = 0.016) and (4) pulmonary tuberculosis and absence of weight loss (P = 0.004). Conclusion: This study demonstrates that the effectiveness of a therapeutic-diagnostic technique in the diagnosis of chronic cough. Consistent with previous studies, there was poor association between most symptoms and the causes of chronic cough. A study involving a larger primary care population is required to confirm the findings found in this analysis.Journal of Family Medicine and Primary Care 09/2014; 3(3):207-12. DOI:10.4103/2249-4863.141611
Allergy, asthma & immunology research 09/2014; 6(5):373-5. DOI:10.4168/aair.2014.6.5.373 · 3.08 Impact Factor