A novel diagnostic algorithm for chronic and subacute cough

Abstract


 
 
 
 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.
 
 
 

Efficacy of sequential three-step empirical therapy for chronic cough

“…In fact, Lu and colleagues have demonstrated that overall therapeutic efficacy was comparable among the various protocols for empirically treating chronic and subacute cough. 22…”

“…In fact, Lu and colleagues have demonstrated that overall therapeutic efficacy was comparable among the various protocols for empirically treating chronic and subacute cough. 22 At present, the medical system in China is undergoing vigorous reform, and is far from perfect. 23,24 Under the current policy of health insurance in Shanghai, patients are allowed to see a doctor in any clinic without the need for referrals and without a significant difference in fees, just like the 'health insurance for all' system in Japan.…”

Association between fractional exhaled nitric oxide (FeNO) cutoff values (25 ppb) and risk factors of cough

“…This cut point may also be used to predict possible benefits with drug therapy, which means low FeNO levels (<25 bbp) indicate possibility of drug dose reduction. Although previous studies have proved the clinical usefulness of FeNO for diagnosing causes of cough types, the evidence about the relationship between the FeNO cutoff value (25 ppb as the critical value) and risk factors of cough are sparse. As we know, to understand the effect of cough‐related factors on the new reported FeNO cutoff value will help us diagnose the cough etiologically.…”