Abstract
OBJECTIVE: The purpose of this study was to test the hypothesis that, using Irwin′s protocol, the majority of nonsmokers with persistent cough can be diagnosed and treated successfully.DESIGN: Retrospective review of patients referred for the investigation of chronic cough.SETTING: Referral out‐patient practice of a hospital‐based pulmonary physician.PATIBNTS: There were 228 patients who satisfied the following entry criteria for inclusion in the data analysis: cough longer than four weeks; nonsmoker; normal chest radiograph; and completion of the required investigations. A total of 198 patients completed the required investigations and returned for the final follow‐up visit.INTERVENTIONS: Diagnostic tests included chest radiographs, pulmonary function tests, radiographs of the sinuses, barium swallow and fibreoptic bronchoscopy.MAIN OUTCOME MEASURES: Status of cough at the time of final follow‐up visit, classified according to four levels: resolved, improved, unchanged or worse.RESULTS: The diagnosis was established in 91 % of patients. The most common diagnoses (alone or in combination) were postnasal drip (26% ), asthma (25% ), gastroesophageal reflux (24%), postinfectious cough (21 %), and cough due to angiotensin‐converting enzyme inhibitors (6%); none had an occult malignancy and one patient had endobronchial tuberculosis. The initial diagnostic impression was best in patients with postinfectious cough (100%) and worst in patients with asthma (25%). The outcome of specific therapy was successful in 91 % of patients.CONCLUSIONS: In the majority of nonsmoking adults cough can be diagnosed and treated successfully. most causes are relatively ′benign′ and the initial clinical impression may be quite misleading, particularly in cough‐variant asthma.
Highlights
PERSISTENT COUGH CAN BE VERY FRUSTRATING FOR THE patient and physician, but a systematic approach to this problem will frequently lead to specific diagnosis and institution of treatment
Those patients who satisfied the following criteria were selected: lifelong nonsmokers, normal radiograph of the chest, and cough lasting longer than four weeks being the sole presenting complaint
Chest x-ray and pulmonary function tests were done in all patients before their first clinical assessment, other investigations were based on clinical judgement
Summary
The files of all patients referred to a single physician (VH) for evaluation of chronic cough were examined. Those patients who satisfied the following criteria were selected: lifelong nonsmokers, normal radiograph of the chest, and cough lasting longer than four weeks being the sole presenting complaint. Investi gations The diagnostic protocol included the following investigations: chest x-rays, pulmonary fu nction tests, histamine inhalation challenge test, barium swallow, radiographs of the sinuses, sputum cultures, exercise-induced asthma test and fibreoptic bronchoscopy. Unless clinical judgment dictated otherwise, the order of investigations was: chest x-ray , pulmonary function tests, histamine challenge test, exercise-induced asthma test, barium swallow, sinus x-rays and fibreoptic bronchoscopy
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