Evaluation and outcome of patients with chronic non-productive cough using a comprehensive diagnostic protocol

• DOI: 10.1136/thx.53.9.738
• Publication Date: 2010-01-11T19:40:22Z
• Authors: L P A McGarvey; L G Heaney; J T Lawson; B T Johnston; C M Scally; M Ennis; D R T Shepherd; J MacMahon
• Keywords: Chronic Cough; Throat

<h3>BACKGROUND</h3> Asthma, post-nasal drip syndrome (PNDS), and gastro-oesophageal reflux (GOR) account for many cases of chronic non-productive cough (CNPC). Each may simultaneously contribute to even when clinically silent, failure recognise their contribution lead unsuccessful treatment. <i>Methods</i>—Patients (all lifetime non-smokers with normal chest radiographs spirometric measurements) referred CNPC persisting more than three weeks as sole respiratory symptom underwent histamine challenge, home peak flow measurements, ear, nose throat (ENT) examination, sinus CT scanning, 24 hour oesophageal pH monitoring. Treatment was prescribed on the basis diagnoses informed by investigation results. <h3>RESULTS</h3> Forty patients (29 women) mean age 47.5 years (range 18–77) duration 67 months 2–240) were evaluated. On a successful response treatment, cause identified in 35 (82%) follows: variant asthma (CVA) (10 cases), PNDS (9 GOR (8 dual aetiologies cases). Histamine challenge correctly predicted CVA 15 17 (88%) positive tests. ENT examination scans each had low predictive values 16 (63%) 12 18 (67%) cases, respectively), suggesting that upper airways disease frequently co-exists but does not always cough. When negative, monitoring effectively ruled out GOR, respectively, <h3>CONCLUSION</h3> This comprehensive approach aids accurate direction treatment and, while CVA, remain most important causes consider, group no identifiable aetiology remains.