Diagnoses and management of adult cough: An Indian Environmental Medical Association (EMA) position paper

Prem, Shankar; Korukonda, Krishnaprasad; Bendre, S.; Behera, Digamber; Mirchandani, Lavina; Awad, Nilkanth Tukaram; Prasad, Rajendra; Bhargava, Salil; Sharma, Omraj; Sk, Jindal

doi:10.1016/j.rmed.2020.105949

Cited by 5 publications

(3 citation statements)

References 48 publications

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“…Several respiratory societies have published guidelines regarding the diagnosis and management of CC. 1,[15][16][17][18][19][20] However, these guidelines are not intended for PCPs and, in general, they do not elaborate in how this first approach or first steps to reach a diagnosis should be carried out in the primary care setting. In this context, the approach of this Delphi project can complement the recommendations of guidelines.…”

Section: Discussionmentioning

confidence: 99%

Basic assessment of chronic cough in primary care and referral pathways of patients to different specialists

Domingo

Jaime²,

Dávila

et al. 2023

Ther Adv Respir Dis

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Background: Chronic cough (CC; cough that lasts 8 weeks or longer) poses major effective assessment challenges. Assessment of CC may vary considerably among medical specialists. Objectives: The aim was to evaluate similarities and consistency of responses across different specialists when performing a basic assessment of CC patients in primary care, and referring patients based on clinical findings or test results. Methods: A modified Delphi approach was used. A survey with 74 statements on initial assessment of CC and referral pathways was addressed to a panel of different specialists, who voted the statements in two rounds. Results: Seventy-seven physicians [18 primary care physicians (PCPs), 24 pulmonologists, 22 allergists, and 13 ear, nose, and throat specialists] from the National Healthcare System of Spain answered the questionnaire. After two rounds, the panel reached a consensus on 63 out of the 74 proposed items (85.1%). Consensus was not reached among the panelists of at least one specialty on 15 out of these 63 agreed items. The panel agreed on those clinical aspects that should be evaluated by PCPs in all patients with CC including the impact of CC on quality of life. Agreement was reached on initial actions to be taken in primary care, including substitution of drugs that may induce cough, performing a chest X-ray, introduction of anti-reflux measures, initiation of empirical anti-reflux pharmacological therapy in some cases, and performing a spirometry with bronchodilator test and hemogram if an etiological diagnosis was not reached. The panelists agreed on a list of diseases that PCPs should assess before referring CC patients. Algorithms were developed for initial assessment and targeted referral of patients with CC from primary care. Conclusion: This study provides the perspective of different medical specialists on how to perform a basic assessment of CC patients in primary care and how and when to refer patients to other specialists.

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Section: Discussionmentioning

confidence: 99%

Basic assessment of chronic cough in primary care and referral pathways of patients to different specialists

Domingo

Jaime²,

Dávila

et al. 2023

Ther Adv Respir Dis

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show abstract

“…Acute, subacute, and chronic cough were defined as suggested in international guidelines [4][5][6][7][8][9][10][11][12]. Current asthma was defined as doctor's diagnosis of asthma at any age and wheezing during the last 12 months [17].…”

Section: Definitions Of Variables Derived From the Raw Datamentioning

confidence: 99%

“…Cough is usually classified according to the length of the episode, to acute (<3 weeks), subacute (3-8 weeks), or chronic (>8 weeks) [4][5][6][7][8][9][10][11][12]. However, this classification is single-dimensional and not based on data-driven analyses.…”

Section: Introductionmentioning

confidence: 99%

Validation of the cough phenotype TBQ among elderly Finnish subjects

et al. 2022

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BackgroundPhenotypes can be utilized in the clinical management of disorders. The approaches to phenotype disorders have evolved from subjective expert opinion to data-driven methodologies. A previous cluster analysis among working-age subjects with cough revealed a phenotype TBQ (Triggers, Background disorders, Quality of life impairment), which included 38% of the subjects with cough. The present study was carried out to validate this phenotyping among elderly, retired subjects with cough.MethodsThis was an observational, cross-sectional study conducted via email among the members of the Finnish Pensioners' Federation (N=26 205, 23.6% responded). The analysis included 1109 subjects with current cough (mean age 72.9 (sd 5.3) years) with 67.7% females). All filled in a comprehensive 86-item questionnaire including the Leicester Cough Questionnaire. Phenotypes were identified utilizing K-means partitional clustering.ResultsTwo clusters were identified. The cluster A included 75.2% and cluster B 24.8% of the subjects. The three most important variables to separate the clusters were the number of cough triggers (mean 2.47 (2.34) versus 7.08 (3.16), respectively, p<0.001), Leicester Cough Questionnaire physical domain (5.38 (0.68) versus 4.21 (0.81), respectively, p<0.001), and the number of cough background disorders (0.82 (0.78) versus 1.99 (0.89), respectively, p<0.001).ConclusionThe phenotype TBQ could be identified also among elderly, retired subjects with cough, thus validating the previous phenotyping among working-age subjects. The main underlying pathophysiological feature separating the phenotype TBQ from the common cough phenotype is probably hypersensitivity of the cough reflex arc.

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Addressing unmet needs for diagnosis and management of chronic cough in the primary care setting

Kardos

Blaiss

Dicpinigaitis

2021

Postgraduate Medicine

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Diagnoses and management of adult cough: An Indian Environmental Medical Association (EMA) position paper

Cited by 5 publications

References 48 publications

Basic assessment of chronic cough in primary care and referral pathways of patients to different specialists

Basic assessment of chronic cough in primary care and referral pathways of patients to different specialists

Validation of the cough phenotype TBQ among elderly Finnish subjects

Addressing unmet needs for diagnosis and management of chronic cough in the primary care setting

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