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Scierka LE, Bradley BA, Glynn E, Davis S, Hoffman M, Tam-Williams JB, Mena-Hurtado C, Smolderen KG. Chronic Cough: Characterizing and Quantifying Burden in Adults Using a Nationwide Electronic Health Records Database. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2024; 8:50-64. [PMID: 38273985 PMCID: PMC10805682 DOI: 10.1007/s41666-023-00150-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 01/27/2024]
Abstract
Chronic cough is a common condition; until recently, no International Classification of Diseases (ICD) code for chronic cough existed; therefore, the true scope and burden of chronic cough is unclear. Using established algorithms, we examined chronic cough patients and their risk profiles, recurrent cough episodes, and subsequent 1-year health care utilization in the nationwide Cerner EHR data resource, compared with those with acute cough. An ICD-based algorithm was applied to the Cerner Health Facts EHR database to derive a phenotype of chronic cough defined as three ICD-based "cough" encounters 14-days apart over a 56-to-120-day period from 2015 to 2017. Demographics, comorbidities, and outcomes (1-year outpatient, emergency, and inpatient encounters) were collected for the chronic cough cohort and acute cough cohort. The chronic cough cohort was 61.5% female, 70.4% white, and 15.2% African American, with 13.7% being of Asian, Native American, or unknown race. Compared with the acute cough cohort, chronic cough patients were more likely to be older, female, and have chronic pulmonary disease, obesity, and depression. Predictors of recurrent chronic cough were older age and race. Those with chronic cough had more outpatient (2.48 ± 2.10 vs. 1.48 ± 0.99; SMD = 0.94), emergency (1.90 ± 2.26 vs. 1.23 ± 0.68; SMD = 0.82), and inpatient (1.11 ± 0.36 vs. 1.05 ± 0.24, SMD = 0.24) encounters compared with acute cough. While EHR-based data may provide a useful resource to identify chronic cough phenotypes, supplementary data approaches and screening methods for chronic cough can further identify the scope of the problem.
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Affiliation(s)
- Lindsey E Scierka
- Vascular Medicine Outcomes (VAMOS) Program, Department of Internal Medicine, Section of Cardiology, Yale University, New Haven, CT USA
| | - Brooklyn A Bradley
- Vascular Medicine Outcomes (VAMOS) Program, Department of Internal Medicine, Section of Cardiology, Yale University, New Haven, CT USA
- Department of Psychiatry, Yale University, 789 Howard Avenue, New Haven, CT 06519 USA
| | - Earl Glynn
- Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO USA
| | - Sierra Davis
- Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO USA
| | - Mark Hoffman
- Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO USA
| | - Jade B Tam-Williams
- Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO USA
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes (VAMOS) Program, Department of Internal Medicine, Section of Cardiology, Yale University, New Haven, CT USA
| | - Kim G Smolderen
- Vascular Medicine Outcomes (VAMOS) Program, Department of Internal Medicine, Section of Cardiology, Yale University, New Haven, CT USA
- Department of Psychiatry, Yale University, 789 Howard Avenue, New Haven, CT 06519 USA
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Ringus DL, Li SH, Vu THT, Guo A, Yuksel S, Arch RS, Patel AK, Patel GB, Peters AT. Management and referral patterns for new-onset chronic cough in primary care patients. Allergy Asthma Proc 2022; 43:e72-e79. [PMID: 36335417 DOI: 10.2500/aap.2022.43.220071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: The diagnosis and management of chronic cough in primary care is challenging despite it being one of the most common chronic conditions. Objective: Clinical characterization of patients with new-onset chronic cough in the primary care setting. Methods: This was a retrospective study of adult patients (ages ≥ 18 years) with at least three visits with primary care providers (PCP) for new-onset cough, with at least 8 weeks between the first and third visits, within a tertiary-care center and affiliated clinics between January 1, 2010, and January 1, 2019 (N = 174). We calculated the frequency of primary care visits, diagnostic testing, specialist referrals, and prescribed medications up to 18 months after the third visit with a PCP for cough. Results: Of 174 patients who met the criteria of new-onset chronic cough, >50% had four or more primary care visits related to cough. Despite that, 91 (52.3%) did not receive a referral to a specialist, and 41 (23.5%) did not receive an order for a chest radiograph during the evaluation of the chronic cough. Antibiotics and systemic corticosteroids were prescribed to 106 (61%) and 63 (36%) of the patients, respectively, and 20% were prescribed opiates. No patients were prescribed central-neuromodulating agents, and angiotensin-converting enzyme inhibitors were discontinued in 48% of the patients who were taking them (12/25). Conclusion: We found considerable heterogeneity and discrepancies with clinical guideline recommendations in patients who presented with new chronic cough. There is a substantial unmet need to study chronic cough in the primary care setting to inform important stakeholders.
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Affiliation(s)
- Daina L Ringus
- From the Division of Allergy and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and
| | - Sylvia H Li
- From the Division of Allergy and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and
| | - Thanh-Huyen T Vu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amina Guo
- From the Division of Allergy and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and
| | - Selcen Yuksel
- From the Division of Allergy and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and
| | - Rebecca S Arch
- From the Division of Allergy and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and
| | - Amee K Patel
- From the Division of Allergy and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and
| | - Gayatri B Patel
- From the Division of Allergy and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and
| | - Anju T Peters
- From the Division of Allergy and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and
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Leuppi JD, Guggisberg P, Koch D, Favre-Bulle A, Fabiani M, Heinz S, Zeller A. Understanding physician's knowledge and perception of chronic cough in Switzerland. Curr Med Res Opin 2022; 38:1459-1466. [PMID: 35369836 DOI: 10.1080/03007995.2022.2057154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cough is one of the most common health issues for which medical attention is sought. A chronic cough (CC) is understood as a cough that lasts longer than 8 weeks. CC encompasses two subsets referred to as refractory chronic cough (RCC) and unexplained chronic cough (UCC). This study aims to assess the current understanding and perceptions of a RCC and UCC, from a physician's perspective in Switzerland and how this understanding and practical work leads to the relevant diagnosis and treatment. METHODS In October 2020, 549 GPs and 338 pulmonologists in Switzerland, received an invite to participate in the online-based quantitative survey. Data collection was carried out through a 25-minute online survey. The questionnaire was based on structured questions, and conducted on a randomized sample of doctors (general practitioners -GPs and pulmonologists) in the German- and French-speaking part of Switzerland. RESULTS Overall, 33 pulmonologists and 52 GPs participated in the online survey. Only 39% of GPs, but 73% of pulmonologists, defined chronic cough as a cough lasting 8 weeks or longer. The majority of physicians (72%), especially pulmonologists (88%), perceived a clinical gap regarding the treatment of persistent cough. 74% of the sampled physicians agreed that persistent cough is a high burden of disease for patients. Based on the answers, the annual number of new patients with RCC and UCC in Switzerland is estimated at 9322 patients. CONCLUSIONS Results of this study have highlighted differences in the terminology used to describe CC (RCC and UCC), in the diagnostic tests used and, in the treatments used between GPs and pulmonologists. These findings suggest the need to align the current language regarding the disease to facilitate a standardized approach for diagnosis and treatment and towards improving patient care and reduce burden of disease for CC (RCC and UCC) patients.
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Affiliation(s)
- Jörg D Leuppi
- Cantonal Hospital Baselland, University Clinic of Medicine and Medical Faculty University of Basel, Basel, Switzerland
| | | | - Daniel Koch
- MSD Merck Sharp & Dohme AG, Lucerne, Switzerland
| | | | | | - Sabina Heinz
- IPSOS Mori Healthcare (Market Access), London, UK
| | - Andreas Zeller
- Centre for Primary Health Care, Medical Faculty, University of Basel, Basel, Switzerland
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Gowan TM, Huffman M, Weiner M, Talib TL, Schelfhout J, Weaver J, Griffith A, Doshi I, Dexter P, Bali V. Management of Chronic Cough in Adult Primary Care: A Qualitative Study. Lung 2021; 199:563-568. [PMID: 34591158 PMCID: PMC8481753 DOI: 10.1007/s00408-021-00478-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Tayler M Gowan
- Regenstrief Institute, Inc., 1101 West Tenth Street, Indianapolis, IN, 46202-4800, USA
| | - Monica Huffman
- Regenstrief Institute, Inc., 1101 West Tenth Street, Indianapolis, IN, 46202-4800, USA
| | - Michael Weiner
- Regenstrief Institute, Inc., 1101 West Tenth Street, Indianapolis, IN, 46202-4800, USA. .,Indiana University, Indianapolis, IN, USA. .,Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
| | - Tasneem L Talib
- Regenstrief Institute, Inc., 1101 West Tenth Street, Indianapolis, IN, 46202-4800, USA
| | | | | | - Ashley Griffith
- Regenstrief Institute, Inc., 1101 West Tenth Street, Indianapolis, IN, 46202-4800, USA
| | | | - Paul Dexter
- Regenstrief Institute, Inc., 1101 West Tenth Street, Indianapolis, IN, 46202-4800, USA.,Indiana University, Indianapolis, IN, USA.,Eskenazi Health, Indianapolis, IN, USA
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Sandage MJ, Ostwalt ES, Allison LH, Cutchin GM, Morton ME, Odom SC. Irritant-Induced Chronic Cough Triggers: A Scoping Review and Clinical Checklist. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1261-1291. [PMID: 33989029 DOI: 10.1044/2021_ajslp-20-00362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The primary aim of this review was to identify environmental irritants known to trigger chronic cough through the life span and develop a comprehensive clinically useful irritant checklist. Method A scoping review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews, checklist, and explanation. English-language, full-text resources were identified through Medline, PsycINFO, SPORTDiscus, Web of Science, and ProQuest Dissertations and Theses Global. Results A total of 1,072 sources were retrieved; of these, 109 were duplicates. Titles of abstracts of 963 articles were screened, with 295 selected for full-text review. Using the exclusion and inclusion criteria listed, 236 articles were considered eligible and 214 different triggers were identified. Triggers were identified from North America, Europe, Africa, Asia, and Australia. Occupational exposures were also delineated. Conclusions A clinically useful checklist of both frequently encountered triggers and idiosyncratic or rare triggers was developed. The clinical checklist provides a unique contribution to streamline and standardize clinical assessment of irritant-induced chronic cough. The international scope of this review extends the usefulness of the clinical checklist to clinicians on most continents.
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Affiliation(s)
- Mary J Sandage
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| | | | - Lauren H Allison
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| | - Grace M Cutchin
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| | | | - Shelby C Odom
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
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Baddini-Martinez J, Chinarelli T, Orlandini CB, de Oliveira MR, Bricoleri I, Cardamoni V, Rodrigues-Junior AL. The Multidimensional Cough Index: A Practical Scale to Measure Cough and Sputum. Am J Med Sci 2021; 362:396-402. [PMID: 33991501 DOI: 10.1016/j.amjms.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/15/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND There currently is a lack of easy-to-use instruments with which to assess cough. The aim of the present study was to develop a scale for measuring the characteristics of cough and sputum. METHODS The authors developed a scale for assessing cough, including aspects such as intensity, frequency, physical impact, psychosocial impacts and sputum characteristics. The first four components were scored using a Cough Index, with a range of 0 to 20. Sputum information included volume, appearance, and hemoptysis. The scale was administered to 105 patients and re-administered to 51 about two weeks later. The patients also reported cough frequency and intensity using a 100-mm visual analogue scale (VAS) and answered the Leicester Cough Questionnaire (LCQ). Additionally, 12 patients with acute exacerbation (AE) of chronic airways disease were interviewed upon admission to and discharge from the hospital. RESULTS Analysis identified only one factor for the Cough Index, and Cronbach's alpha value was 0.819. Cough Index was significantly correlated with VASfrequency (r = 0.651, p < 0.0001), VASintensity (r = 0.543, p<0.0001), and LCQ (r = -0.824, p < 0.0001). The intraclass correlation coefficient of test-retest scores was 0.779. The median Cough Index significantly decreased after AE treatment, as did the number of patients reporting increased sputum production and greenish and dark sputum. A Cough Index ≥ 4 distinguished respiratory patients from healthy subjects, with a sensitivity of 80% and a specificity of 85%. CONCLUSION The Multidimensional Cough Index condenses complex aspects related to cough and sputum production into a single instrument, with satisfactory validation.
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Affiliation(s)
- José Baddini-Martinez
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil; Present Institution, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil.
| | - Tamiris Chinarelli
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Caisa Brunelli Orlandini
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Mariane Rocha de Oliveira
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Isabela Bricoleri
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Victor Cardamoni
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Slovarp LJ, Jetté ME, Gillespie AI, Reynolds JE, Barkmeier-Kraemer JM. Evaluation and Management Outcomes and Burdens in Patients with Refractory Chronic Cough Referred for Behavioral Cough Suppression Therapy. Lung 2021; 199:263-271. [PMID: 33821355 PMCID: PMC8203529 DOI: 10.1007/s00408-021-00442-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/23/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to investigate the typical symptoms and medical management characteristics of adult patients with refractory chronic cough (RCC) who are referred to speech-language pathology (SLP) for behavioral cough suppression therapy (BCST) in order to estimate cost-effectiveness and efficiency of current practice patterns for this population. METHODS One hundred sixty-four (164) patients with RCC referred for BCST were surveyed. Patients completed an initial survey at BCST onset related to symptom pattern and prior treatment, including the Leicester Cough Questionnaire (LCQ). Every four to six weeks patients completed follow-up surveys to assess their response to BCST. RESULTS Mean age was 58 years (83.5% women). The majority of patients reported their cough began two or more years prior to BCST. Approximately half (49%) reported seeing four or more physicians (including primary care physicians) and being prescribed four or more medications (57%) prior to BCST. Medications targeting post-nasal drip (72%), reflux (70%), asthma (56%), and allergies (56%) were most commonly prescribed. BCST resulted in a clinically significant improvement in 70.1% of participants. The mean change in LCQ for those who improved with BCST was 6.61. Over half (58%) reported they were quite satisfied to completely satisfied with their treatment response. The average time from enrollment to study completion was 64 days. CONCLUSION The results of this study suggest early intervention with BCST may be a cost-effective and efficient option for patients with RCC.
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Affiliation(s)
- Laurie J Slovarp
- School of Speech, Language, Hearing, & Occupational Sciences, University of Montana, 32 Campus Dr., Missoula, MT, USA.
| | - Marie E Jetté
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Amanda I Gillespie
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jane E Reynolds
- School of Speech, Language, Hearing, & Occupational Sciences, University of Montana, 32 Campus Dr., Missoula, MT, USA
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Gao X, Hu G, Yan P. Causes of chronic cough in adolescent and adult patients. Med J Islam Repub Iran 2020; 34:166. [PMID: 33816365 PMCID: PMC8004569 DOI: 10.47176/mjiri.34.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Adolescents differ from adults in certain aspects, but the differences in the etiology of chronic cough between adolescents and adults have not been specifically investigated. The purpose of this study is to evaluate the causes of chronic cough in adolescent patients in comparison with those in adult patients.
Methods: The electronic medical records were retrospectively screened for patients with the initial diagnosis of chronic cough from 2016 to 2018. Clinical variables and the causes of chronic cough were collected in patients who met inclusion criteria. Patients were assigned to adolescent (13 to 18 years) and adult (> 18 years) group based on age. The distribution of causes of chronic cough was compared by t-test and χ2 tests between adolescent and adult groups using SPSS. Significant level was set at 0.05.
Results: The enrolled patients consisted of 16 adolescents and 73 adults with chronic cough. The most common causes of chronic cough were cough-variant asthma and upper airway cough syndrome in both adolescents and adults. The frequency of post infectious cough in adolescents was significantly higher than that in adults (12.5% vs. 1.36%; p= 0.024). Although no significant difference between the two groups was found, there was a trend that suggested that habitual cough was more common in the adolescent group (6.25%:1.36%); while gastroesophageal reflux disease (GERD) did not show similar results (6.25%:20.54%).
Conclusion: There are moderate differences in the causes of chronic cough between adolescent and adult patients. Realizing those differences would be helpful for clinicians to establish an appropriate differential diagnosis and make referral decisions.
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Affiliation(s)
- Xiaofang Gao
- Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Guangrong Hu
- Department of Respiratory Medicine, 989 Hospital of Chinese People's Liberation Army, Luoyang, China
| | - Peng Yan
- Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
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A fluorescent coordination polymer for TNP detection and protection effect on cough after infection by up-regulates the activity of neuroendopeptide enzyme in respiratory tract mucosa. JOURNAL OF POLYMER RESEARCH 2020. [DOI: 10.1007/s10965-020-02299-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lin J, Wang Z, Qiu C, Wang Z, Jiang S, Tang H, Wang X, Qiu Z, He Y, Zhao J, Shi G, Sun S, Wang L, Chen L, Wang J, Mao A. A multicenter, prospective, observational study on montelukast monotherapy or montelukast-based combinations treating cough variant asthma. J Thorac Dis 2020; 12:6573-6585. [PMID: 33282359 PMCID: PMC7711367 DOI: 10.21037/jtd-20-1989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Evidence of treatment against cough variant asthma (CVA) is insufficient for the clinical practice in China. We aimed at evaluating the real-world effectiveness of montelukast (MONT) alone or in combination with low-dose inhaled corticosteroids (ICS) and low-dose ICS plus long-acting beta-2-agonists (LABA) for Chinese CVA patients in a multicentre, prospective, cohort study. Methods Adult patients diagnosed with CVA defined as chronic cough >8 weeks with a positive bronchial provocation test and normal chest X-ray findings were enrolled at respiratory clinics. Study treatment followed routine clinical practice. The investigators initiated MONT by 10 mg/day alone or in combination with a low-dose ICS +/− LABA and followed up treatment outcomes for 4 weeks. The primary outcome measure was the change in cough score (CS) from baseline. Results The study enrolled 247 patients (MONT =146, MONT + ICS =38, MONT + ICS/LABA =63). In the primary analysis, the mean change (95% CI) in CS at the end of the study was −1.2 (−1.6, −0.9), −0.9 (−1.5, −0.4), and −1.3 (−1.7, −0.8) in the three groups, respectively. MONT monotherapy had a satisfactory rate of weekly asthma control at the end of the study (83.5%, 95% CI: 75.1%, 89.4%) in the per-protocol analysis. Rates of weekly asthma control were similar in two MONT-based combination regimens (83.9%, 81.4%). Short-acting beta-2-agonist (SABA) user (≥2 times per week) was 16.8% in the MONT group. Conclusions The real-world effectiveness of MONT alone or in combination with ICS or ICS and LABA was acceptable for CVA short-term control.
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Affiliation(s)
- Jiangtao Lin
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zaiyi Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Chen Qiu
- Department of Pulmonary and Critical Care Medicine, Shenzhen People's Hospital, Shenzhen, China
| | - Zhen Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shanping Jiang
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Huaping Tang
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Xuefen Wang
- Department of Respiratory, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Zhongmin Qiu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yong He
- Department of Pulmonary and Critical Care Medicine, Daping Hospital, Amy Military Medical University, Chongqing, China
| | - Jianping Zhao
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Guochao Shi
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shenghua Sun
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Limin Wang
- Department of Pulmonary and Critical Care Medicine, Hangzhou First People's Hospital, Hangzhou, China
| | - Lin Chen
- Global Medical Affairs, Merck Research Laboratories, MSD China, Shanghai, China
| | - Jue Wang
- Global Medical Affairs, Merck Research Laboratories, MSD China, Shanghai, China
| | - Annhua Mao
- Global Medical Affairs, Merck Research Laboratories, MSD China, Shanghai, China
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Zhan W, Zhang L, Jiang M, Chen M, Yuan X, Sun J, Xu P, Wu F, Zhang C, Luo W, Chen X, Li H, Lai K. A new simple score of chronic cough: cough evaluation test. BMC Pulm Med 2020; 20:68. [PMID: 32197604 PMCID: PMC7083055 DOI: 10.1186/s12890-020-1106-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/02/2020] [Indexed: 01/17/2023] Open
Abstract
Background Chronic cough has an important impact on physical, social and psychological aspects. A simple and effective method to assess different aspects of chronic cough severity is required. We aimed to develop a simple, self-completed test, Cough Evaluation Test (CET), to evaluate cough severity and its impact on health. Method The items of preliminary CET were generated based on literature review and clinical practice. Items reduction was conducted by modified Delphi method. Patients with chronic cough were recruited to complete CET, Cough Visual Analog Scales (VAS), Mandarin Chinese version of the Leicester Cough Questionnaire (LCQ-MC), and Cough Symptom Score (CSS). Reassessments were performed at 1 week apart before treatment, and after more than 2 weeks treatments. Concurrent validation, internal consistency, repeatability, responsiveness and the minimal important difference (MID) were determined. Results CET consists of five items with a 5-point Likert scale (1–5 scaling of items, 5–25 score range). The Cronbach’s alpha values for CET was 0.80. CET showed a stronger correlation with LCQ-MC (r = − 0.74) compared to that between LCQ-MC with VAS (r = − 0.61). CET also showed a stronger correlation with VAS (r = 0.70) compared to that between VAS with other measures. Intraclass correlation coefficients for CET was 0.84. In patients undergoing treatment, CET scores significantly changed (p < 0.0001). The MID of CET was 2. Conclusion Cough Evaluate Test is a reliable, valid and responsive tool to simply evaluate impact of cough on physical, social and psychological aspects.
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Affiliation(s)
- Wenzhi Zhan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, Guangdong, 510120, P. R. China
| | - Liting Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, Guangdong, 510120, P. R. China
| | - Mei Jiang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, Guangdong, 510120, P. R. China
| | - Meihua Chen
- Respiratory Department of the Third People's Hospital of Dongguan city, Dongguan, Guangdong, P. R. China
| | - Xiaoling Yuan
- Zhongshan Hospital of Sun Yat-sen University, Zhongshan People's Hospital, Zhongshan, Guangdong, P. R. China
| | - Jianxin Sun
- The Second People's Hospital of Zhaoqing, Zhaoqing, Guangdong, P. R. China
| | - Pusheng Xu
- Department of Respiratory, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P. R. China
| | - Feng Wu
- Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, Guangdong, P. R. China
| | - Chunlai Zhang
- Jiangmen Central Hospital, Jiangmen, Guangdong, P. R. China
| | - Wei Luo
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, Guangdong, 510120, P. R. China
| | - Xiaomei Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, Guangdong, 510120, P. R. China
| | - Hu Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, Guangdong, 510120, P. R. China
| | - Kefang Lai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, Guangdong, 510120, P. R. China.
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12
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Allergic and Mixed Rhinitis: Diagnosis and Natural Evolution. J Clin Med 2019; 8:jcm8112019. [PMID: 31752308 PMCID: PMC6912750 DOI: 10.3390/jcm8112019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/06/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022] Open
Abstract
Chronic rhinitis (CR) is divided into two main categories: allergic rhinitis (AR) and nonallergic rhinitis (NAR). These conditions are more recognizable to an experienced clinician, as they can be more clearly demarcated diagnostically. However, an additional 30% to 50% of patients with CR might have an overlap of NAR and AR, referred to as mixed rhinitis (MR). Progress in elucidating the pathophysiologic mechanisms behind MR and NAR has been made in the past several years, and there are now several guidelines published to assist the clinician in accurately diagnosing AR, NAR, and MR. Clinical history and subjective symptoms can provide clues for differentiating AR from MR and NAR, but allergy testing is recommended to confirm these conditions. Progress in accurately diagnosing patients with CR will be made as studies incorporate subjective (i.e., validated questionnaires such as the irritant index questionnaire (IIQ), medication responsiveness, and quality-of-life tools) and objective (i.e., nasal cytologic testing, nasal provocation, and biomarkers) methods characterizing rhinitis subtypes.
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Bronchoscopy for Chronic Unexplained Cough: Use of Biopsies and Cultures Increase Diagnostic Yield. J Bronchology Interv Pulmonol 2019; 27:30-35. [PMID: 31651543 DOI: 10.1097/lbr.0000000000000629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prior studies assessing the diagnostic utility of bronchoscopy for chronic unexplained cough have focused primarily on identifying endobronchial anomalies to determine chronic cough etiology. On the basis of our institutional experience, expanding bronchoscopy to include cultures and biopsies can considerably increase its diagnostic yield for identifying the etiology of chronic unexplained cough. MATERIALS AND METHODS This retrospective review analyzed bronchoscopies conducted in our institution between 2013 and 2017. Eligibility criteria were bronchoscopies conducted for chronic unexplained cough for which no etiology had been identified before the bronchoscopy. Microbiology, pathology, and cytology results from bronchoscopy were reviewed to identify the etiology of the cough. RESULTS Over the study period, 169 bronchoscopies met the eligibility criteria. The average patient age at bronchoscopy was 59.7±14.8 years; 61% were female individuals. Direct visualization identified anatomic etiologies in 48 (28%) patients, most commonly tracheobronchomalacia, and less common conditions, such as tracheobronchopathia osteochondroplastica. Microbiology cultures were positive in 33 (20%) patients, principally Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and nontuberculosis mycobacterium. Pathology results from endobronchial biopsies identified respiratory conditions associated with cough, primarily eosinophilic bronchitis (n=15), as well as neurofibromatosis (n=1) and amyloidosis (n=1). Cytology results did not reveal alternate diagnoses not previously identified. CONCLUSION Inclusion of bronchial washings and endobronchial biopsies during bronchoscopy for chronic unexplained cough increased diagnostic yield from 28%, attributable to directly visualized anatomic etiologies, to 41%. The addition of microbiology cultures and pathology analysis significantly increased the diagnostic yield of bronchoscopy in identifying the potential etiology of chronic heretofore unexplained cough.
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14
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Liu X, Wang X, Yao X, Wang Y, Sun Y, Zhang L. Value of Exhaled Nitric Oxide and FEF 25-75 in Identifying Factors Associated With Chronic Cough in Allergic Rhinitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:830-845. [PMID: 31552718 PMCID: PMC6761070 DOI: 10.4168/aair.2019.11.6.830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 01/06/2023]
Abstract
Purpose Chronic cough in allergic rhinitis (AR) patients is common with multiple etiologies including cough variant asthma (CVA), non-asthmatic eosinophilic bronchitis (NAEB), gastroesophageal reflux-related cough (GERC), and upper airway cough syndrome (UACS). Practical indicators that distinguish these categories are lacking. We aimed to explore the diagnostic value of the fraction of exhaled nitric oxide (FeNO) and forced expiratory flow at 25% and 75% of pulmonary volume (FEF25–75) in specifically identifying CVA and NAEB in these patients. Methods Consecutive AR patients with chronic cough were screened and underwent induced sputum, FeNO, nasal nitric oxide, spirometry, and methacholine bronchial provocation testing. All patients also completed gastroesophageal reflux disease questionnaires. Results Among 1,680 AR patients, 324 (19.3%) were identified with chronic cough, of whom 316 (97.5%) underwent etiology analyses. Overall, 87 (27.5%) patients had chronic cough caused by NAEB, 78 (24.7%) by CVA, 16 (5.1%) by GERC, and 81 (25.6%) by UACS. Patients with either NAEB or CVA (n = 165, in total) were further assigned to a common group designated as CVA/NAEB, because they both responded to corticosteroid therapy. Receiver operating characteristic curves of FeNO revealed obvious differences among CVA, NAEB, and CVA/NAEB (area under the curve = 0.855, 0.699, and 0.923, respectively). The cutoff values of FeNO at 43.5 and 32.5 ppb were shown to best differentiate CVA and CVA/NAEB, respectively. FEF25–75 was significantly lower in patients with CVA than in those with other causes. A FEF25–75 value of 74.6% showed good sensitivity and specificity for identifying patients with CVA. Conclusions NAEB, CVA, and UACS are common causes of chronic cough in patients with AR. FeNO can first be used to discriminate patients with CVA/NAEB, then FEF25–75 (or combined with FeNO) can further discriminate patients with CVA from those with CVA/NAEB.
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Affiliation(s)
- Xiaofang Liu
- Department of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiangdong Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education of China, Beijing Institute of Otolaryngology, Beijing, China
| | - Xiujuan Yao
- Department of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuhong Wang
- Department of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yongchang Sun
- Department of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China.
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education of China, Beijing Institute of Otolaryngology, Beijing, China.
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15
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Zadeh J, Andreoni A, Treitl D, Ben-David K. Spotlight on the Linx™ Reflux Management System for the treatment of gastroesophageal reflux disease: evidence and research. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:291-300. [PMID: 30214323 PMCID: PMC6124788 DOI: 10.2147/mder.s113679] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The initial approach to gastroesophageal reflux disease (GERD) management typically involves lifestyle modification and medical therapy utilizing acid reducing agents such as histamine blockers and proton pump inhibitors. In severe cases refractory to such treatments, surgical therapy may be indicated. The gold standard for surgical treatment of GERD is the laparoscopic Nissen fundoplication. In recent years, a new technique known as magnetic sphincter augmentation (MSA) has been developed using the Linx™ Reflux Management System. This is an implantable ring of magnetic beads that is placed around the esophagus at the gastroesophageal junction to restore lower esophageal integrity. The aim of this review is to discuss the current literature regarding indications, surgical technique, efficacy, and complications of MSA using the Linx device. METHODS A standardized literature search was performed yielding 367 abstracts. After elimination due to duplicates between databases and irrelevance, 96 articles remained. The information found to be significant and non-redundant was included in this review. CONCLUSION After several years of clinical application, the Linx device has been shown to not only be effective for the management of GERD but also be as effective as fundoplication. With respect to safety, the most common complication of MSA is dysphagia. This often resolved without intervention, but esophageal dilation or device explanation are occasionally necessary. Not fully appreciated in earlier reviews, erosion of the device into the esophagus appears to be the most significant complication of the device after extended follow-up. While very rare, the potentially severe consequences of this phenomenon suggest that the device should be used with some restraint and that patients should be made aware of this potential morbidity. Fortunately, in the few cases of device erosion described in the literature reviewed, the Linx device was easily and safely removed.
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Affiliation(s)
- Jonathan Zadeh
- Department of Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA,
| | - Anthony Andreoni
- Department of Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA,
| | - Daniela Treitl
- Department of Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA,
| | - Kfir Ben-David
- Department of Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA,
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16
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Slovarp L, Loomis BK, Glaspey A. Assessing referral and practice patterns of patients with chronic cough referred for behavioral cough suppression therapy. Chron Respir Dis 2018; 15:296-305. [PMID: 29430939 PMCID: PMC6100168 DOI: 10.1177/1479972318755722] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 11/17/2017] [Accepted: 12/15/2017] [Indexed: 12/19/2022] Open
Abstract
The purpose of this exploratory research was to describe current referral and practice patterns for behavioral cough suppression therapy (BCST) throughout the United States, and to assess the need for improving the efficiency of BCST referral patterns. In study I, 126 speech-language pathologists, who treat patients with refractory chronic cough (RCC) in the United States, completed a survey about referral patterns, cough duration, and patient frustration level. In study II, 36 adults with RCC referred for BCST completed a four-part survey about cough symptoms and treatment. The survey included the Leicester Cough Questionnaire (LCQ) before and after BCST. Study I revealed significant patient frustration about the treatment process and the wait-time for BCST. Participants in study II reported average cough duration of over 2 years before BCST. Twenty-seven of 31 participants in study II improved by at least 1.3 on the LCQ, indicating a clinically significant improvement in 87% of patients. This study suggests that the current management model for CC may be unduly time-consuming, and expensive for patients with CC who are successfully treated with BCST. Practitioners are encouraged to consider BCST earlier in the treatment process.
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Affiliation(s)
- Laurie Slovarp
- Department of Communicative Sciences and Disorders, University of Montana, Missoula, Montana, USA
| | | | - Amy Glaspey
- Department of Communicative Sciences and Disorders, University of Montana, Missoula, Montana, USA
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17
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Soni RS, Ebersole B, Jamal N. Treatment of Chronic Cough: Single-Institution Experience Utilizing Behavioral Therapy. Otolaryngol Head Neck Surg 2016; 156:103-108. [DOI: 10.1177/0194599816675299] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective Chronic cough remains a challenging condition, especially in cases where it persists despite comprehensive medical management. For these particular patients, there appears to be an emerging role for behavior modification therapy. We report a series of patients with refractory chronic cough to assess if there is any benefit of adding behavioral therapy to their treatment regimen. Study Design A case series with planned chart review of patients treated for chronic cough. Setting The review was performed with an outpatient electronic health record system at a tertiary care center. Subjects and Methods The charts of all patients treated for chronic cough by a single laryngologist over a 30-month period were analyzed. Patients’ response to treatment and rate of cough improvement were assessed for those with refractory chronic cough who underwent behavior modification therapy. Results Thirty-eight patients with chronic cough were initially treated empirically for the most common causes of cough, of which 32% experienced improvement. Nineteen patients who did not significantly improve with medical management underwent behavior modification therapy with a speech-language pathologist. Of these patients, 84% experienced resolution or marked improvement of their symptoms. Conclusion Behavioral therapy may be underutilized in practice and could lead to improvement of otherwise recalcitrant cough.
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Affiliation(s)
- Resha S. Soni
- Department of Otolaryngology–Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Barbara Ebersole
- Department of Otolaryngology–Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
- Department of Speech Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Nausheen Jamal
- Department of Otolaryngology–Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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18
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Paz C, Suárez E, Vence J. CFD transient simulation of the cough clearance process using an Eulerian wall film model. Comput Methods Biomech Biomed Engin 2016; 20:142-152. [DOI: 10.1080/10255842.2016.1206532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Aspiration of foreign matter into the airways and lungs can cause a wide spectrum of pulmonary disorders with various presentations. The type of syndrome resulting from aspiration depends on the quantity and nature of the aspirated material, the chronicity, and the host responses. Aspiration is most likely to occur in subjects with a decreased level of consciousness, compromised airway defense mechanisms, dysphagia, gastroesophageal reflux, and recurrent vomiting. These aspiration-related syndromes can be categorized into airway disorders, including vocal cord dysfunction, large airway obstruction with a foreign body, bronchiectasis, bronchoconstriction, and diffuse aspiration bronchiolitis, or parenchymal disorders, including aspiration pneumonitis, aspiration pneumonia, and exogenous lipoid pneumonia. In idiopathic pulmonary fibrosis, aspiration has been implicated in disease progression and acute exacerbation. Aspiration may increase the risk of bronchiolitis obliterans syndrome in patients who have undergone a lung transplant. Accumulating evidence suggests that a causative role for aspiration is often unsuspected in patients presenting with aspiration-related pulmonary diseases; thus, many cases go undiagnosed. Herein, we discuss the broadening spectrum of these pulmonary syndromes with a focus on presenting features and diagnostic aspects.
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Affiliation(s)
- Xiaowen Hu
- Department of Respiratory Disease, Anhui Provincial Hospital, Hefei, China
| | - Joyce S Lee
- Department of Medicine, University of California, San Francisco, CA
| | - Paolo T Pianosi
- Pediatric Pulmonology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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20
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Vitale J, Caruthers C, Warrier MR. A curious case of cough. Ann Allergy Asthma Immunol 2015; 114:80-2. [PMID: 25624127 DOI: 10.1016/j.anai.2014.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 11/05/2014] [Accepted: 11/20/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Josie Vitale
- Department of Pediatrics, Division of Allergy & Immunology, Saint Louis University, St Louis, Missouri.
| | - Carrie Caruthers
- Department of Pediatrics, Division of Allergy & Immunology, Saint Louis University, St Louis, Missouri
| | - Manoj R Warrier
- Department of Pediatrics, Division of Allergy & Immunology, Saint Louis University, St Louis, Missouri; Allergy, Asthma & Sinus Care Center, St Louis, Missouri
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Haydour Q, Alahdab F, Farah M, Barrionuevo P, Vertigan AE, Newcombe PA, Pringsheim T, Chang AB, Rubin BK, McGarvey L, Weir KA, Altman KW, Feinstein A, Murad MH, Irwin RS. Management and diagnosis of psychogenic cough, habit cough, and tic cough: a systematic review. Chest 2014; 146:355-372. [PMID: 24833061 DOI: 10.1378/chest.14-0795] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Several pharmacologic and nonpharmacologic therapeutic options have been used to treat cough that is not associated with a pulmonary or extrapulmonary etiology. METHODS We conducted a systematic review to summarize the evidence supporting different cough management options in adults and children with psychogenic, tic, and habit cough. Medline, EMBASE, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus were searched from the earliest inception of each database to September 2013. Content experts were contacted, and we searched bibliographies of included studies to identify additional references. RESULTS A total of 18 uncontrolled studies were identified, enrolling 223 patients (46% male subjects, 96% children and adolescents). Psychogenic cough was the most common descriptive term used (90% of the studies). Most of the patients (95%) had no cough during sleep; barking or honking quality of cough was described in only eight studies. Hypnosis (three studies), suggestion therapy (four studies), and counseling and reassurance (seven studies) were the most commonly used interventions. Hypnosis was effective in resolving cough in 78% of the patients and improving it in another 5%. Suggestion therapy resolved cough successfully in 96% of the patients. The greatest majority of improvements noted with these forms of therapy occurred in the pediatric age group. The quality of evidence is low due to the lack of control groups, the retrospective nature of all the studies, heterogeneity of definitions and diagnostic criteria, and the high likelihood of reporting bias. CONCLUSIONS Only low-quality evidence exists to support a particular strategy to define and treat psychogenic, habit, and tic cough. Patient values, preferences, and availability of potential therapies should guide treatment choice.
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Affiliation(s)
- Qusay Haydour
- Mayo Clinic, The Knowledge and Evaluation Research Unit and the Center for the Science of Health Care Delivery, Rochester, MN.
| | - Fares Alahdab
- Mayo Clinic, The Knowledge and Evaluation Research Unit and the Center for the Science of Health Care Delivery, Rochester, MN
| | - Magdoleen Farah
- Mayo Clinic, The Knowledge and Evaluation Research Unit and the Center for the Science of Health Care Delivery, Rochester, MN
| | - Patricia Barrionuevo
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru; Mayo Clinic, The Knowledge and Evaluation Research Unit and the Center for the Science of Health Care Delivery, Rochester, MN
| | - Anne E Vertigan
- John Hunter Hospital, Department of Speech Pathology, Newcastle, NSW, Australia
| | - Peter A Newcombe
- University of Queensland, School of Psychology, Brisbane, QLD, Australia
| | | | - Anne B Chang
- Royal Children's Hospital and Menzies School of Health Research, Charles Darwin University, Brisbane, Brisbane, QLD, Australia
| | - Bruce K Rubin
- Children's Hospital of Richmond and Virginia Commonwealth University, Richmond, VA
| | - Lorcan McGarvey
- Centre for Infection and Immunity, The Queen's University of Belfast, Belfast, Northern Ireland
| | - Kelly A Weir
- Royal Children's Hospital Department of Speech Pathology and Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Mohammad Hassan Murad
- Mayo Clinic, The Knowledge and Evaluation Research Unit and the Center for the Science of Health Care Delivery, Rochester, MN
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Chan NJ, Soliman AMS. Angiotensin converting enzyme inhibitor-related angioedema: onset, presentation, and management. Ann Otol Rhinol Laryngol 2014; 124:89-96. [PMID: 25059449 DOI: 10.1177/0003489414543069] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study aimed to determine the duration of use, presentation, and management of angiotensin converting enzyme (ACE) inhibitor-related angioedema patients at an urban academic medical center. METHODS Retrospective chart review. RESULTS Eighty-eight patients who presented with ACE inhibitor-related angioedema between January 1, 2012, and December 31, 2012, were identified. They presented anywhere from 1 day to 20 years after starting an ACE inhibitor. About half the patients (50.7%) presented after taking an ACE inhibitor for at least 1 year. Fifty-five patients were female (62.5%). Twenty-eight patients (31.8%) had an airway intervention with 27 intubated and 1 requiring cricothyroidotomy. Six patients were intubated after more than 1 flexible laryngoscopy. The percentage of patients with involvement of the face, lips, tongue, floor of mouth, soft palate/uvula, and larynx were 12.5%, 60.2%, 39.7%, 6.8%, 17.0%, and 29.5%, respectively. Sixty-eight percent of patients with laryngeal edema were intubated. The majority of patients were treated with a corticosteroid and H1 and H2 receptor antagonists. CONCLUSION Angioedema can occur at any time after starting ACE inhibitor use, with nearly half occurring after 1 year of use. Laryngeal involvement occurred in a minority of patients, but most of these patients were felt to require airway protection.
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Affiliation(s)
- Norman J Chan
- Department of Otolaryngology-Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ahmed M S Soliman
- Department of Otolaryngology-Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
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Sridaran S, Gonzalez-Estrada A, Aronica MA. A case of cough variant asthma undiagnosed for 16 years. Oxf Med Case Reports 2014; 2014:29-30. [PMID: 25988016 PMCID: PMC4369981 DOI: 10.1093/omcr/omu012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/02/2014] [Accepted: 04/07/2014] [Indexed: 11/17/2022] Open
Abstract
A 64-year-old female patient presented with a 16-year history of persistent dry cough that was undiagnosed after workups at several healthcare facilities. The patient denies wheezing, shortness of breath or sputum production. Previous workups include chest imaging, transthoracic echocardiogram (TTE), laryngoscopy, spirometry and bronchoscopy, all of which were unremarkable. During her current evaluation, spirometry was ordered again for the patient, which showed a post-bronchodilator improvement in the FEV1 by 13%, strongly suggestive of asthma. The patient was started on pharmacological therapy for severe persistent asthma, which led to sustained symptomatic improvement per evaluation at follow-up after 2 months. Spirometric findings, clinical presentation and resolution of symptoms with adequate therapy for asthma suggest that this is a case of cough variant asthma that went undiagnosed for several years. This case report summarizes the workup for chronic cough and how the diagnosis of cough variant asthma can be missed.
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Affiliation(s)
- Sankar Sridaran
- Case Western Reserve University School of Medicine , Cleveland, OH 44195 , USA
| | - Alexei Gonzalez-Estrada
- Department of Allergy and Clinical Immunology , Respiratory Institute, Cleveland Clinic Foundation , Cleveland, OH 44195 , USA
| | - Mark A Aronica
- Department of Pathobiology and Department of Allergy and Clinical Immunology , Respiratory Institute, Cleveland Clinic Foundation , Cleveland, OH 44195 , USA
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