Response

Abstract

There are three issues embodied within Dr. Reich's letter that are deserving of comment. The first relates to his reference to Samuel Johnson, an important figure during the American revolutionary war period, who used language when describing and defining cough suggesting that the act of coughing had the potential to have severe and traumatic consequences and that this has been appreciated for at least hundreds of years. The second issue could best be described as an English lesson for many of us who have never before used the word “amanuenses.” According toThe American Heritage Dictionary, “amanuenses” is the plural of “amanuensis,” a noun, that is defined as “one who is employed to take dictation or to copy manuscript.”1The American Heritage Dictionary of the English Language. Fourth ed. Boston MA: Houghton Mifflin Company, 2000Google ScholarWhile amanuensis is a Latin word that originated in ancient Rome to refer to a slave performing any command for his master, it has been used in academic contexts, for example, when an injured or disabled person is helped by an amanuensis at a written examination.2Wikipedia, The Free Encyclopedia. Amanuensis. Boston, MA: Free Software Foundation, Inc., 2002Google ScholarBy referring to Samuel Johnson, quoting his definition of cough, and using the word “amanuenses,” Dr. Reich has not applied the razor of William of Occam, who wrote, “Pluritas non est ponenda sine necessitate [Entities should not be multiplied unnecessarily]” (ie, the principle of parsimony or, in the modern vernacular, “keep it simple” or “get to the point”).3Weg JG Irwin RS Sounds like a PE to Me: response to letter to the editor..Chest. 1997; 112: 856Abstract Full Text Full Text PDF Google Scholar The third issue relates to the possibility that cough may “beget” cough. In suggesting this possibility, Dr. Reich refers to our recently published study,4Irwin RS Ownbey R Cagle PT et al.Interpreting the histopathology of chronic cough: a prospective, controlled, comparative study..Chest. 2006; 130: 362-370Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholarwhich suggested that the airway inflammation associated with chronic cough may be due to the trauma of coughing, and that the characteristics of the inflammation from trauma may be indistinguishable from those of the underlying disease causing cough. The clinical and research implications of our findings are twofold: investigators must be cautious when imputing pathogenetic importance to observed inflammatory changes in the airways of coughing subjects; and, as suggested by Dr. Reich, studies should be performed to determine whether a sustained trial of cough suppression might eliminate chronic cough in patients whose cough is potentially perpetuated by the trauma of coughing itself. While it is an intriguing thought that a cough self-perpetuating cycle may potentially explain some of the causes of unexplained cough, cough suppression with a potent, potentially addicting agent such as a narcotic will probably be required and theoretically will work only if the original cause of cough has disappeared. Consequently, therapeutic trials with potent cough suppressants should be conducted for limited and finite periods of time. To test this hypothesis, future research will be needed to determine which, if any, cough suppressants might be of benefit5Bolser DC Cough suppressant and pharmacologic protussive therapy: ACCP evidence-based clinical practice guidelines..Chest. 2006; : 238S-249SAbstract Full Text Full Text PDF PubMed Scopus (130) Google Scholarand to determine the time period of active cough suppression. Because there is a strong suspicion that a likely cause of chronic cough was actually present in many cases mislabeled as having an unexplained cough (ie, idiopathic cough) due to incomplete or inadequate evaluation or treatment,6Pratter MR Unexplained (idiopathic) cough: ACCP evidence-based clinical practice guidelines..Chest. 2006; : 220S-221SAbstract Full Text Full Text PDF PubMed Scopus (56) Google Scholarclinicians should diagnose chronic cough and treat patients according to the best available evidence, such as the ACCP cough guidelines,7Diagnosis and management of cough: ACCP evidence-based clinical practice guidelines.Chest. 2006; : 1S-292SPubMed Google Scholarbefore considering a trial of potent cough suppressant therapy for a putative unexplained chronic cough. Chronic Idiopathic CoughCHESTVol. 131Issue 2PreviewCough: A convulsion of the lungs, vellicated by some sharp serosity. It is pronounced coff. Full-Text PDF