Chronic cough: a gastroenterology perspective

Managing patients with chronic cough: challenges and solutions

Chronic cough is a common complaint and a frequent cause of medical consultation. Its management can be difficult. We present here an overview of the current guidelines for the management of chronic cough. Different steps are detailed, including the initial research of an obvious etiology and alert signs that should lead to further investigation of underlying condition. The diagnosis of the most frequent causes: asthma, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux disease and upper airway cough syndrome should be considered, assessed and treated accordingly. Recent advances have been made in the comprehension of refractory chronic cough pathophysiology as well as its pharmacologic and non-pharmacologic treatment, especially speech pathology therapy.

A novel diagnostic algorithm for chronic and subacute cough

BACKGROUND

Cough remains the most common reason for patients to seek medical attention. We practised a novel diagnostic algorithm for chronic and subacute cough.

METHODS

Chronic and subacute cough patients with normal chest X-ray results and without respiratory tract infections in the preceding eight weeks were recruited. The patients were divided into two groups: Group A, patients with typical symptoms and signs of postnasal drip syndrome (PNDS), asthma syndromes (AS) and gastroesophageal reflux disease (GERD); Group B, patients without the typical symptoms and signs. The two groups received targeted or sequential empirical trials of therapy according to the algorithm.

RESULTS

Among the 524 patients available for analysis in Groups A and B, 436 (83.6%) were diagnosed to have PNDS (34.2%), AS (44.5%) and/or GERD (10.1%), among which 26 had two causes (6.0%) and 6 had three causes (1.4%). After empirical trials of therapy, 81.5% of the patients were diagnosed. The mean time for diagnosis was considerably shorter in Group A (13.1 ± 5.6 d) than in Group B (23.4 ± 7.2 d) (p < 0.01). The diagnosis rate of the first trial in Group A (54.1%) was significantly higher than that in Group B (28.6%, p < 0.01).

CONCLUSIONS

The proposed algorithm is a promising and practical approach to diagnose chronic and subacute cough.