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Diagnostic tests in respiratory medicine
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
The three most common causes of chronic cough are upper airway cough syndrome, asthma and GERD, but there are often multiple causes. Furthermore, acute viral cough is the costliest healthcare problem. Acute cough is defined as more than 3 weeks of symptoms; subacute is indicated by 3–8 weeks of symptoms and longer than 8 weeks is defined as a chronic cough. Chronic cough can be triggered and arise anywhere in the bronchial tree.
Pulmonary Medicine
Published in James M. Rippe, Manual of Lifestyle Medicine, 2021
Acute cough is one that has been present for less than three weeks (2). The most common cause of acute cough is respiratory infection, which is typically characterized by spittle production and may be accompanied by a raw substernal sensation. Subclinical bronchial spasm may also cause acute cough. Mild asthma may also present with acute cough. Some exposures to allergens, cold air, or exercising may result in a transient cough. Pulmonary function tests, including spirometry, are often needed to make a specific diagnosis. Hyper-reactive airways without wheezing can present as a chronic cough, which has been termed cough-variant asthma. GERD also is a common cause of chronic cough. Chronic bronchitis which is defined as a productive cough present for more than three months a year for more than two years is another cause of chronic cough. A chest X-ray is often helpful in determining abnormalities that may result in a chronic cough.
Therapeutic intervention
Published in Stephanie Martin, Working with Voice Disorders, 2020
Irritation in the vocal tract is frequently an early symptom of a muscle tension dysphonia. Therefore, the advice relating to irritation is relevant to chronic cough once physical causes, which can be treated, have been eliminated or medication prescribed: voice care advice,breathing techniques,release of constriction.
Usefulness of simultaneous impulse oscillometry and spirometry with airway response to bronchodilator in the diagnosis of asthmatic cough
Published in Journal of Asthma, 2023
Namiko Taniuchi, Mitsunori Hino, Akiko Yoshikawa, Akihiko Miyanaga, Yosuke Tanaka, Masahiro Seike, Akihiko Gemma
CVA is diagnosed by coughing without wheezing for more than 8 weeks, the absence of wheezing on auscultation, and response to bronchodilators (6). In clinical practice, bronchodilators are rarely used as single agents to diagnose CVA, and some clinicians do not consider the bronchodilator an effective part of the diagnostic criteria. Bronchodilators are also effective in COPD-derived cough and cough-dominant BA, and making a differential diagnosis using traditional domestic diagnostic criteria can be challenging. The US and European guidelines list four causes of chronic cough, namely, upper airway cough syndrome, asthma, non-asthmatic eosinophilic bronchitis, and GERD (10,36). These are causes for chronic cough in patients who are nonsmokers not on ACE inhibitors. However, several problems have been raised. First, it is quite difficult to assign the diagnosis of patients complaining of cough to one of these four diseases. Furthermore, the mechanisms by which these underlying diseases cause cough are not well understood. This study’s purpose and benefit of distinguishing between BA and CVA in patients with chronic cough are that they have different prognoses and treatment strategies (e.g. the risk of fatal severe attacks and the need to continue ICS prophylactic inhalation).
Prescribing the right therapy for the treatment of chronic cough: a critical focus on current and investigational options
Published in Expert Opinion on Pharmacotherapy, 2022
Paola Rogliani, Clive Page, Luigino Calzetta
The COUGH-1 and COUGH-2 studies [20] reported also a very large and unexpected placebo response. Although such a placebo effect could be related with the neurobiological mechanisms and psychological effects of immersion in a clinical environment, we cannot exclude that the beneficial placebo effect was due to better-than-usual clinical monitoring and patient care by the study investigators during the trial period [24,25]. This suggests that a significant and possibly clinically appreciable reduction in cough frequency may be achieved simply by increasing the intensity and quality of medical care provided by physicians, regardless of any pharmacological treatment, and that the patients enrolled in the COUGH-1 and COUGH-2 studies [20] probably suffered from a less severe form of refractory or unexplained chronic cough than that detected at baseline.
Addressing unmet needs for diagnosis and management of chronic cough in the primary care setting
Published in Postgraduate Medicine, 2021
Peter Kardos, Michael Blaiss, Peter Dicpinigaitis
Initial assessment, including medical history, detailed evaluation of cough triggers (e.g. odors, fume, dust, temperature changes, speaking several minutes on the telephone), checking treatment with ACE inhibitors and other substances, physical examination, chest X-ray, and spirometry, should be performed in every case of chronic cough, preferably in primary care. Empiric treatment trials for potential identified conditions (e.g. UACS, asthma, or cough-variant asthma) may also be conducted in primary care according to the guidelines discussed above; however, prescribing PPIs to patients who do not present with typical intraesophageal reflux symptoms is not recommended [3]. If these tests and empiric treatment trials are inconclusive, patients should be referred to specialists (e.g. specialist cough clinics (if accessible), pulmonologists, allergists, otolaryngologists) for further evaluation and screening for common conditions associated with chronic cough. Performance of additional types of diagnostic tests (e.g. chest CT) in primary care is not recommended as it may lead to unnecessary diagnostic testing, burden, and costs for the patient. A comprehensive list of the ‘do’s’ and ‘don’ts’ associated with diagnosis of chronic cough is summarized in Table 2.