Cases Of Chronic Cough Research Articles

The current and emerging treatment landscape for chronic cough.

Cough serves a protective physiologic function as a vital defensive reflex preventing aspiration. However, exposure to viral infections or other triggers induces, in some individuals, a chronic cough (CC) that causes a significant symptomatic burden. Most cases of CC are due to conditions that respond to appropriate therapeutic trials (upper airway cough syndrome; asthma; reflux). Unfortunately, a significant subgroup of patients will have refractory CC, which does not respond to treatment of known underlying causes of CC. Currently, available therapeutic options for refractory CC are inadequate due to limited efficacy and frequently intolerable adverse effects. Current professional society guideline recommendations are discussed, and a promising pipeline of antitussive drugs in development is introduced, including purinergic 2X3 receptor antagonists, neurokinin-1 receptor antagonists, oral mixed ĸ-opioid receptor agonists/µ-opioid receptor antagonists, and voltage-gated sodium channel blockers.

Is mass screening enough to control tuberculosis in Ecuador's prisons?

ObjectiveTo evaluate mass screening campaigns for tuberculosis in prisoners in Ecuador.Material and methodCross-sectional study of Chronic Cough (CC) detected amongst inmates who entered two prisons in Ecuador between January and December 2016 (n = 12,365). The time distribution of the CCs was analyzed with the uniformity test and its relationship with the diagnosed cases of PTB, the prevalence of PTB was calculated. A logistic regression model was performed to determine the factors modifiers of PTB positivity.Results1.332 chronic cougher were recorded, the positivity rate was 17.3% (95% CI, 15.1-19.4), and the prevalence was 1.9% (95% CI, 1.6 - 2.1). There was an absence of uniformity in the detection and diagnosis by epidemiological weeks; there was a positive correlation between CC and PTB cases. The positivity rate was associated with the prison with the highest density (adjusted OR 3.8; 95% CI, 2.5-5.5).DiscussionMassive screening campaigns are not enough to control tuberculosis in Ecuador’s prisons. The incidence found is high. It is necessary to strengthen the diagnostic process to treat all the cases found and thus break the chain of transmission.

Chronic cough caused by choledochoduodenal fistula: a case report

BackgroundChronic cough is characterized by cough as the only or main symptom, with a duration of more than 8 weeks and no obvious abnormality in chest X-ray examination. Its etiology is complex, including respiratory disease, digestive system disease, circulation system disease, and psychological disease. Although a set of etiological diagnosis procedures for chronic cough have been established, it is still difficult to diagnose chronic cough and there are still some patients with misdiagnosis.Case presentationWe present a case of a 54-year-old female patient who had chronic cough for 28 years. Physical examination had no positive signs and she denied any illness causing cough like tuberculosis, rhinitis. Recurrent clinic visits and symptomatic treatment didn’t improve the condition. Finally, gastroscopy identified the possible etiology of choledochoduodenal fistula that was proved by surgery. And after surgery, the patient's cough symptoms were significantly improved.ConclusionWe report a rare case of chronic cough caused by choledochoduodenal fistula which demonstrates our as yet inadequate recognition of the etiology and pathogenesis. Written informed consent was obtained from the patient.

KERNEL OF TRUTH: AN INTERESTING CASE OF FOREIGN BODY ASPIRATION

SESSION TITLE: Medical Student/Resident Signs and Symptoms of Chest Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Foreign body aspiration (FBA) is commonly seen in the pediatric and elderly population. Risk factors include encephalopathy, stroke, alcoholism and neuromuscular disorders affecting swallowing reflex. It is rare in the adult population except in cases of unconscious accidental ingestion. The most common symptom of FBA is chronic cough, which is nonspecific and can often be mistakenly approached as an infectious process. Here we describe a case of a patient who had no significant risk factors, presented with chronic cough and was found to have a lung mass on imaging but ultimately diagnosed with foreign body aspiration. CASE PRESENTATION: A 60-year-old male presented to the pulmonary office for a progressive productive cough of two-year duration. Chest roentgenogram (CXR) showed a dense opacification in the right middle lobe concerning for pneumonia versus obstructive lesion. He completed a 10-day course of levofloxacin but with no improvement of symptoms. He denied history of travel, sick contacts, pet exposure, or incarceration. He had intermittent febrile episodes and a twenty-pound weight loss. He was a non-smoker and didn’t drink alcohol. On physical examination, he had decreased breath sounds on the right lung field. Laboratory workup was significant for leukocytosis. Chest computed tomography showed complete opacification of the right middle lobe (RML) with abrupt cut off of the RML bronchus concerning for an obstructive mass along with subcarinal and right hilar lymphadenopathy (Figure 1). He underwent diagnostic bronchoscopy in which two yellow, spherical foreign body fragments were found to be obstructing the RML bronchus (Figure 2). Both specimens were removed successfully, and further gross examination was consistent with corn kernels. Bronchoalveolar lavage and endobronchial biopsies were negative for malignancy. After foreign body removal, patients' symptoms subsequently improved. DISCUSSION: FBA in the tracheobronchial tree is more common in the pediatric population than adults. Common risk factors in adults include advanced age, stroke, neuromuscular diseases such as myasthenia gravis, and alcohol abuse. Given the lack of such risk factors, prolonged duration of symptoms, and imaging concerning for malignancy, the diagnosis of FBA was not suspected. Undiagnosed FBA can lead to complications such as recurrent pneumonia, atelectasis, or bronchiectasis. Flexible bronchoscopy is the treatment of choice for the diagnosis and removal of FBA. CONCLUSIONS: Due to the predisposition for a delayed diagnosis of FBA in the healthy adult population, a high index of suspicion and thorough history taking is warranted when dealing with cases of chronic cough and recurrent pneumonia to avoid long term sequelae. Reference #1: Kam JC, et al. Foreign Body Aspiration Presenting with Asthma-Like Symptoms. Case Reports in Medicine. 2013;2013:1-4. Reference #2: Cataneo AJM, Reibscheid SM, Ruiz RL, Ferrari GF. Foreign Body in the Tracheobronchial Tree. Clinical Pediatrics. 1997;36(12):701-705. Reference #3: Malinowska E, Dabrowska-Kruszewska J, Doboszynska A, Stangiewicz M, Gugala K, Biernacki M. Foreign Body in the Airway a Female Patient with Myasthenia Gravis. Advances in Experimental Medicine and Biology Pathophysiology of Respiration. 2015:29-36. DISCLOSURES: No relevant relationships by Anthony Cucci, source=Admin input No relevant relationships by NICOLE LAO, source=Web Response No relevant relationships by Joseph Michael Lim, source=Web Response No relevant relationships by Elizabeth Verghese, source=Web Response

Cough presentation in primary care and the identification of chronic cough: a need for diagnostic clarity?

Objective: To investigate patterns of presentation of cough in primary care and develop an algorithm to identify probable and possible chronic cough (CC).Methods: This retrospective observational study used routine English primary care data and linked hospital data. Patients with ≥1 cough event in the study period (March 2014–February 2015) were selected. Index date was that of the earliest cough event in this period. Adults (aged ≥18 years) were classified as having probable CC if they had an explicit CC diagnosis; as having possible CC if they had ≥3 cough events recorded over 8–26 weeks; or, otherwise, as having acute cough. Underlying conditions associated with CC were identified.Results: 198,151 people were identified. 56.5% were female; median age was 47.0 years. The prevalence of cough in the study year was 17.6%. Of the 150,213 identified adults, 1600 (1.1%), 10,913 (7.3%) and 137,718 (91.7%) were classified as having probable CC, possible CC or acute cough, respectively. Compared with probable CC and acute cough, a higher percentage of possible CC cases had a record on or prior to index date indicative of chronic obstructive pulmonary disease (30.6% versus 10.1% and 9.7%), gastro-esophageal reflux disease (32.6% versus 24.9% and 21.1%) or asthma (45.9% versus 27.6% and 27.9%). Prevalences of probable and possible CC were 0.18% and 1.2%, respectively.Conclusions: The prevalence of CC was lower than reported in previous studies. People with possible CC had higher rates of underlying conditions associated with CC. These observations may suggest poor recognition and/or under-recording of CC in primary care.

An Intriguing Case of Chronic Cough in a Child

An Intriguing Case of Chronic Cough in a Child

A Case of Chronic Cough and Pneumonia Secondary to a Foreign Body

Foreign body aspiration occurs when a solid or semisolid object becomes lodged in the larynx or trachea. It can be a life-threatening emergency, especially if it is large enough to occlude the airway. However, small aspirated objects may go unnoticed until symptoms occur. Therefore, it is frequently misdiagnosed. A high level of clinical suspicion, patient's risk factors, and thorough history and physical examination are essential in making the diagnosis. It should be considered in cases where there is unresolved chronic cough with or without associated recurrent pneumonia especially in patients with risks for aspiration.

An Unusual Case of Chronic Cough and Dyspnea

An Unusual Case of Chronic Cough and Dyspnea

Comparative analysis of clinical profile: Chronic cough vs paradoxical vocal fold motion

BackgroundOngoing contention surrounding typical demographic and clinical attributes of chronic cough (CC) and paradoxical vocal fold motion (PVFM) impedes timely diagnosis and optimum patient care. Designed to reduce preventable patient morbidity through improved recognition and differentiation, the current study aimed to determine representative clinical profiles for CC and PVFM, with identification of distinctive attributes from the general population and risk factors associated with each diagnosis. MethodsSelf-reported medical questionnaires, demographic and lifestyle attributes of CC and PVFM cases from a disease-specific outcomes database were compared to US population data and published normative values. Univariate comparison and multivariate regression modelling of age, sex, alcohol intake, smoking, Reflux Symptom Index (RSI), Voice Handicap Index (VHI), and Generalized Anxiety Disorder 7-item Scale (GAD-7) determined distinguishing features between the clinical groups, including odds ratios for presenting with CC versus PVFM. ResultsClinical profiles developed from 283 (128 CC, 155 PVFM) adults (18–91years) were significantly different from the general population across each demographic, lifestyle and clinical variable (all p < .01), with the exception of obesity. Age (55.39 ± 13.54 vs 45.07 ± 16.51years, p < .01) and mean RSI score (21.5 ± 9.02 vs 18.1 ± 9.08, p < .01) most reliably distinguished CC from PVFM, with those aged 60–69 years (OR = 9.45) most likely to be diagnosed with CC. ConclusionsStandard clinical profiles of CC and PVFM are distinct from the general population, aiding determination of relative probabilities and risk factors in the differential diagnostic process. Variations between CC and PVFM were subtle, reliably distinguished by age and relative severity of laryngopharyngeal reflux symptomatology.

A Case of Chronic Cough with Progressive Breathlessness in a 32 Year-old Male Health Worker – Tuberculosis?, Allergic Bronchitis?, Asthma?

Introduction: Although tuberculosis is hyper-endemic in India and is responsible for a huge proportion of respiratory morbidity, adequate workup should be conducted to rule out other differential diagnosis wherever applicable. Case Report: A 32 year old male health worker was suffering from productive cough and gradually increasing breathlessness since three months. The investigations conducted were a sputum analysis and a chest x-ray, both of which were normal and hence he was treated as a case of allergic bronchitis. Subject presented to us after three months with no relief. We further investigated him and found severe eosinophilia in the peripheral blood, a positive anti-filarial antibody and a negative triple stool test for ova and parasites. He was treated with diethylcarbamazine and albendazole+ivermectin combination. The patient responded well and had no complaints at the end of the 4 week treatment. Discussion and Conclusion: The subject should have been evaluated by conducting a basic investigation like a complete blood count. Delay in treatment of cases of tropical pulmonary eosinophilia can lead to permanent respiratory morbidity.

A case of chronic cough caused by achalasia misconceived as gastroesophageal reflux disease.

Cough is one of the most common symptoms that causes patients to seek outpatient medical care. If cough persists longer than 8 weeks, common causes of chronic cough, such as upper airway cough syndrome, asthma, and gastroesophageal reflux disease (GERD), should be considered. Although not a common cause of chronic cough, achalasia may cause symptoms very similar to reflux that can lead to its misdiagnosis as GERD. In this report, a 40-year-old woman presenting with chronic cough was initially diagnosed with GERD; however, her symptoms were refractory to conventional GERD treatment. Finally, she was diagnosed with achalasia. Her cough improved completely after pneumatic dilatation. Achalasia is a rare disease accompanied by dysphagia or regurgitation. If cough presumably due to GERD does not respond to treatment, or if the cause of chronic cough is uncertain, physicians should suspect achalasia.

Chronic cough in preschool children

Cough may be the first overt sign of disease of the airways or lungs when it represents more than a defense mechanism, and may by its persistence become a helpful pointer of potential disease for both patient and physician. On the other hand, impairment or absence of the coughing mechanism can be harmful and even fatal; this is why cough suppression is rarely indicated in childhood. Pediatricians are concerned more with the etiology of the cough and making the right diagnosis. Whereas chronic cough in adults has been universally defined as a cough that lasts more than 8weeks, in childhood, different timing has been reported. Many reasons support defining a cough that lasts more than 4weeks in preschool children as chronic, however; and this is particularly true when the cough is wet. During childhood, the respiratory tract and nervous system undergo a series of anatomical and physiological maturation processes that influence the cough reflex. In addition, immunological response undergoes developmental and memorial processes that make infection and congenital abnormalities the overwhelming causes of cough in preschool children. Cough in children should be treated on the basis of etiology, and there is no evidence in support of the use of medication for symptomatic cough relief or adopting empirical approaches. Most cases of chronic cough in preschool age are caused by protracted bacterial bronchitis, tracheobronchomalacia, foreign body aspiration, post-infectious cough or some combination of these. Other causes of chronic cough, such as bronchiectasis, asthma, gastroesophageal reflux, and upper respiratory syndrome appear to be less frequent in this age group. The prevalence of each depends on the population in consideration, the epidemiology of infectious diseases, socioeconomic aspects, and the local health system.

Study on the treatment of 130 cases of chronic cough in children caused by mycoplasma pneumoniae infection

Objective To analyze the correlation between mycoplasma pneumoniae (MP) infection and chronic cough in children,according to the test results of serological,discuss the macrolides sequential therapy effect.Methods From May 2011 to May 2012 in our hospital 270 cases of chronic cough in children were detected serum MP-IgM antibody by passive agglutination method,130 cases were MP-IgM positive,divided into observation group and control group.The observation group was given macrolide sequential therapy,control group received azithromycin treatment,and we observed the effects of two groups.Results The treatment efficiency:the observation group and the control group were 97.0％ and 85.9％ respectively (P＜0.05),with statistical significance; total serum MPIGM negative rate:the observation group and the control group were 95.5％ and 82.8％ respectively (P＜0.05),with statistical significance.Conclusion MP infection is one of the important pathogenic factors of chronic cough in children,macrolide antibiotic sequential therapy treatment has a better curative effect. Key words: Chronic cough in children; MP; Serum MP-IGM; Macrolides sequential therapy

Chiari type I malformation

To highlight an unusual cause of chronic cough, we present two cases of chronic cough in older children referred to a pediatric otolaryngology outpatient clinic with persistent symptoms despite extensive previous workup and treatment. Cranial neuropathy was identified in each case. As a result, magnetic resonance imaging was performed revealing Chiari type I malformation. In each case, surgical decompression provided symptom improvement. Chronic cough is a rare presenting symptom in children with Chiari type I malformation. We emphasize the significance of awareness for unusual cases of cough to aid in the correct identification and treatment in children.

On Relation between Chronic and Persistent Cough of Children and MP Infection and Clinical Observation and Treatment

Objective To explore the relation between chronic and persistent cough of children and MP infection and clinical observation and treatment.Methods Retrospective Study of the 55 children chronic and persistent cough cases, with a clinical features as pneumonia MP infection, in my hospital from March 2005 to March 2008.Results ①Clinical Feature:major symptom of these 55 children chronic cough cases is chronicand persistent cough.58%(32/55)of the cases showed no symptoms in their lungs.②Peripheral Blood:85％(47/55)cases showed no obvious changes in peripheral blood, with their WBC ranging from(4～10)×109/Land their eosinophile granulocyte increased.③Special Test:47.27%(26/55)IgM (MP-IgM)antibody positive,83.64%(46/55)cased showed pneumonia MP DNA specificity after PcR Test.④X-Rate Report:Results varied.Conclusion Pneumonia MP Infection is one of the pathogeny causing chronic and persistent cough of children.Treating the infection is a very important solution in curing chronic and persistent cough of children. Key words: Children; Chronic and Persistent Cough; MP; Clinical Observation and Treatment

Chronic Cough as the Presenting Symptom of Hydrocephalus

Chronic cough is defined as a daily cough lasting for more than eight weeks. We report an unusual case of chronic cough as the primary manifestation of obstructive hydrocephalus. Chronic cough in our case was determined to be of neurogenic origin only after exhaustive investigations failed to reveal a systemic cause, and, in particular, after a positive response to treatment of the hydrocephalus was observed. To the best of our knowledge, this is the first report of hydrocephalus presenting as chronic cough. We believe this case will remind physicians of the importance of considering neurological disease as a cause of chronic cough after common causes are excluded.

20年間長期介在した気管支異物(魚骨)により慢性咳嗽と肺炎を繰り返した1例

20年間長期介在した気管支異物(魚骨)により慢性咳嗽と肺炎を繰り返した1例

Quantitative Determination of Chemical Constituents from Seeds of Nigella sativa L. by using HPLC-UV and Identification by LC-ESI-TOF

Nigella sativa Linn. belongs to the Ranunculaceae family and is an indigenous herbaceous plant that is more commonly known as the fennel flower plant. The plant is also known as black cumin (English) and black-caraway (USA). The spicy seeds from this plant have medicinal usage dating back to the ancient Egyptians, Greeks and Romans. In Egypt and the Middle East the black seed oil is popularly used for certain cases of chronic cough and bronchial asthma [1,2]. An HPLC method was developed for the simultaneous determination of nine compounds of Nigella sativa L. The separation was achieved within 23 minutes by using C-18 column material, a water/acetonitrile mobile phase, both containing 0.1% acetic acid gradient system and a temperature of 35°C. The method was validated for linearity, repeatability, limits of detection (LOD) and limits of quantification (LOQ). The LOD and LOQ of nine compounds were found to be in the range from 0.09–10 µg/mL and 0.3–25 µg/mL, respectively. The wavelength used for quantification with the diode array detector was 205 and 260 nm. The seeds of N. sativa and commercial products showed the presence of all nine compounds. LC-mass spectrometry coupled with electrospray ionization (ESI) interface method is described for the identification of compounds in Nigella sativa L. samples. This method involved the use of [M+H]+ and [M+Na]+ ions in the positive ion mode with extractive ion monitoring (EIM). Acknowledgements: This research is funded in part by “Science Based Authentication of Dietary Supplements” Funded by the Food and Drug Administration grant number 2 U01 FD 002071-07.

CHLAMYDIA PNEUMONIAE (CPN): A COMMON CAUSE OF CHRONIC COUGH

PURPOSE: Cpn is the second most commonly diagnosed atypical pathogen in the United States. We report several cases of chronic cough, lasting more than 8 weeks, that were resistant to all prior therapy, but were improved after being diagnosed with Cpn, and treated with a regimen of antibiotics and symptomatic drug therapy.

Inhibitors of the Renin–Angiotensin System: Proven Benefits, Unproven Safety

The most important contribution of the systematic reviews by Matchar and colleagues and Kunz and associates is that they tell us what we do not know, which is the adverse effects of long-term thera...