The spectrum, clinical features and diagnosis of chronic cough due to rare causes

Lai, Kefang; Tang, Jiaman; Zhan, Wenzhi; Hu, Li; Yi, Fang; Li, Long; Zhou, Jianmeng; Chen, Xiaomei; Huang, Lianrong; Sun, Zhangyu; Jiang, Ziyu; Chen, Yuehan; Lu, Hankun; Luo, Wei; Chen, Ruchong; Zhong, Nanshan

doi:10.21037/jtd-20-2671

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…Rare causes of chronic cough in adults account for <15% of cases and commonly include protracted bacterial bronchitis, somatic cough syndrome (which is more common in children), diffuse panbronchiolitis and obstructive sleep apnoea syndrome 54 . However, only limited high-quality evidence is available regarding their prevalence and clinical implications in adults with chronic cough.…”

Section: Epidemiologymentioning

confidence: 99%

Cough hypersensitivity and chronic cough

Chung

McGarvey

Song

et al. 2022

Nat Rev Dis Primers

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160

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Chronic cough is globally prevalent across all age groups. This disorder is challenging to treat because many pulmonary and extrapulmonary conditions can present with chronic cough, and cough can also be present without any identifiable underlying cause or be refractory to therapies that improve associated conditions. Most patients with chronic cough have cough hypersensitivity, which is characterized by increased neural responsivity to a range of stimuli that affect the airways and lungs, and other tissues innervated by common nerve supplies. Cough hypersensitivity presents as excessive coughing often in response to relatively innocuous stimuli, causing significant psychophysical morbidity and affecting patients’ quality of life. Understanding of the mechanisms that contribute to cough hypersensitivity and excessive coughing in different patient populations and across the lifespan is advancing and has contributed to the development of new therapies for chronic cough in adults. Owing to differences in the pathology, the organs involved and individual patient factors, treatment of chronic cough is progressing towards a personalized approach, and, in the future, novel ways to endotype patients with cough may prove valuable in management.

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Section: Epidemiologymentioning

confidence: 99%

Cough hypersensitivity and chronic cough

Chung

McGarvey

Song

et al. 2022

Nat Rev Dis Primers

Self Cite

160

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“… 1 Many conditions present chronic cough as sole symptom, including cough variant asthma, eosinophilic bronchitis, upper-airway cough syndrome, gastroesophageal reflux cough, 2 , 3 as well as some rare causes like protracted bacterial bronchitis, obstructive sleep apnea syndrome, and vocal cord disfunction. 4 Sometime no pathological causes of cough could be identified even after full investigations or cough still persist after treatment directed to the potential conditions. Those patients are defined as refractory chronic cough or unexplained chronic cough.…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics in adult patients with somatic cough syndrome

Lai

Peng

Zhan

et al. 2022

Ther Adv Respir Dis

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Objective: The data in regard of the clinical characteristics and diagnosis of somatic cough syndrome in adults were limited. The aim of this study was to fill that gap. Methods: This was a retrospective analysis of patients with somatic cough syndrome. We described clinical characteristics of adult patients with somatic cough syndrome. Results: Twenty-three somatic cough syndrome patients were identified in 543 adult patients with chronic cough. Psychiatric disorder of these patients was identified as anxiety ( n = 8), obsessive-compulsive ( n = 7), somatoform ( n = 6), depression ( n = 3), and cognitive bias ( n = 1). Twelve patients showed abnormal results of investigations related with common causes of chronic cough, including gastroesophageal reflux, sputum eosinophilia, bronchial hyper-responsiveness, or signs of sinusitis but did not respond to the treatments directed to those conditions. All these patients were ever misdiagnosed as other causes of chronic cough. Compared to 520 non-somatic cough syndrome patients, patients with somatic cough syndrome were younger (32 (29.0–43.0) vs 42.0 (32.0–55.0) years, p = 0.013), longer disease duration (48.0 (19.5–102.0) vs 24.0 (9.0–72.0) months, p = 0.037), more common in dry cough (100% vs 57.6%, p < 0.001), and lower proportion of nocturnal cough (13.0% vs 40.2%, p = 0.009). Common cold (60.9%) was the most common initial trigger of cough and itchy throat (60.9%) was the most common accompanying symptom in patients with somatic cough syndrome. Notably, there were similar distribution in cough triggers and accompanying symptoms between two groups. Conclusion: In spite of much higher proportion of dry cough and smaller proportion of nocturnal cough, adult patients with somatic cough syndrome show similar clinical characteristics with other chronic cough patients, in regard of cough triggers, accompanying symptoms as well as abnormal results of investigations, which should be an important reason for misdiagnosis of somatic cough syndrome. Psychiatric disorder should be addressed in clinical management of chronic cough.

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“…Common causes of cough in the preschool age are post-infectious airway infections, airway anomalies, or asthma (32). However, PBB is more common in preschool-aged children and marginally more common in males (33,34). A study (35) that recruited 903 children presenting with acute cough and followed-up for development of chronic cough found that the risk factors for PBB were: childcare attendance [adjusted relative risk (aRR) = 2.32, 95% CI 1.48-3.63], prior history of chronic cough (aRR = 2.63, 95% CI 1.72-4.01), and age <2-years (<12-months: aRR = 4.31, 95% CI 1.42-13.10; 12-<24 months: aRR = 2.00, 95% CI 1.35-2.96).…”

Section: Pre-school Childrenmentioning

confidence: 99%

History Taking as a Diagnostic Tool in Children With Chronic Cough

et al. 2022

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Chronic cough is a common symptom of many underlying respiratory and non-respiratory disorders and may be associated with less serious causes, such as gastroesophageal reflux and nasal diseases. Chronic cough in children differs from that in adults with respect to its etiologies and management since it can indicate a symptom of an underlying disease in children. Guidelines for managing chronic cough in children are based on recording the history, followed by physical examination, chest radiography, and spirometry. Thus, taking accurate respiratory history for coughing helps delineate the pathophysiological basis of the cause of chronic cough. Detailed history taking enhances the evaluation and treatment, and facilitates a tailored diagnostic identification of likely diagnoses. While studies have described evidence-based red flags in children with chronic cough, the value of skilled physicians regarding history taking has received less attention for the best patient care. In the present article, we outline the major questions comprising a detailed history taking for chronic cough in children.

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The spectrum, clinical features and diagnosis of chronic cough due to rare causes

Cited by 5 publications

References 27 publications

Cough hypersensitivity and chronic cough

Cough hypersensitivity and chronic cough

Clinical characteristics in adult patients with somatic cough syndrome

History Taking as a Diagnostic Tool in Children With Chronic Cough

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