Cause Of Chronic Cough Research Articles

Association between chronic idiopathic cough and sensitive skin syndromes is a new argument in favor of common neuropathic pathways: results from a survey on 4050 subjects

Sensitive skin syndrome has a neuropathic origin, which is why it is frequently associated with irritable bowel syndrome. We have looked for a possible association with chronic cough, which is commonly maintained by neurogenic mechanisms, whatever the initial cause(s). A survey was carried out on a representative sample of the population over 15 years of age using the quota method. The questionnaire included sociodemographic data and questions about sensitive skin, the presence of chronic cough, smoking and possible causes of chronic cough. Chronic cough was assessed by the Leicester Cough Questionnaire, and 4050 subjects responded (mean age: 45 years). Overall, 12.2% of subjects with a chronic cough were compared to the 87.8% without any cough. Among them, 72.5% had sensitive skin (vs. 47.8%, p < 0.001); additionally, 17.4% of the subjects with sensitive skin had a chronic cough (vs. 6.9% if no sensitive skin). These proportions were higher if very sensitive skin was reported. The risk of having chronic cough was twice as high if sensitive skin was reported [OR = 1.9 (1.5–2.4), p < 0.001]. The risk of having sensitive skin was also twice as high for chronic cough. Thus, chronic cough and sensitive skin are frequently associated. This association represents a new argument in favor of a neuropathic nature of sensitive skin. Sensitive skin and chronic cough are both modes of overreaction to environmental factors, which tend to be autonomized by neurogenic mechanisms. Dermatologists should ask their patients if they have a chronic cough, and pneumologists should ask about the presence of sensitive skin.

Frequency of protracted bacterial bronchitis and management pre-respiratory referral.

To determine the frequency of protracted bacterial bronchitis (PBB) in children referred to tertiary care with chronic cough and describe management prior to referral. A retrospective cohort study of all new patients with a history of ≥4 weeks of cough seen at the only tertiary paediatric outpatient respiratory service in Western Australia between July 2018 and June 2019. Medical records were reviewed until a final diagnosis was documented or otherwise for a period of 18 months. PBB was the most common cause and comprised 37.9% of all children referred to tertiary respiratory care with chronic cough. In children with PBB, the median cough duration at the time of first specialist review was 5.1months (IQR 2.1-12.0months). The most common referral source of PBB was primary practice (40.9%) and the most common working diagnosis pre-referral was asthma (15.9%). Seventy-eight percent of children with PBB had an ongoing cough at their first respiratory review, and of these, only 13.5% had been prescribed 4 weeks of antibiotics prior to their respiratory review. Asthma treatment had been prescribed for 34.0% of children with PBB. PBB is the most common cause of chronic cough in children referred to tertiary respiratory care and is frequently misdiagnosed and undertreated pre-referral. There is a need to facilitate diagnosis and optimal management of PBB in primary care, which could result in earlier symptom resolution and potentially limit disease progression to bronchiectasis.

Upper airway cough syndrome may be the main cause of chronic cough in Japan: a cohort study.

Upper airway cough syndrome (UACS) is generally considered a common cause of chronic cough but remains poorly recognised in Japan. This study aimed to assess whether UACS was a common cause of chronic cough in Japan, as is true in other countries. Interview and examination items were evaluated for their potential use in UACS diagnosis. All patients with chronic cough were preliminarily diagnosed with bronchial asthma, UACS, gastroesophageal reflux disease, or postinfectious prolonged cough, based on interviews and examinations. Treatment centred on nasal steroids was administered to the UACS group and standard treatment to the other groups. The observation period lasted 4 weeks. The subjective cough score at first diagnosis was set at 10, and the final diagnosis was made based on the treatment administered at the time the cough score had decreased to ≤2. The associations between the presence or absence of UACS and interview and examination items were statistically evaluated. Among 230 patients with chronic cough, 146 were diagnosed with UACS-only. Multivariate logistic regression revealed that the assessment items 'awareness of mucus accumulating in the back of the throat', 'presence of abnormal echography findings', 'absence of associated coughing when exercising' and 'presence of coughing persisting after onset' were significantly correlated with the presence or absence of UACS (p < 0.05). UACS may be the most common cause of chronic cough in Japan and may be effectively treated with nasal corticosteroids. Diagnosing UACS might be possible by selecting appropriate interview and examination items.

Differential features of chronic cough according to etiology and the simple decision tree for predicting causes

Finding etiology of chronic cough is an essential part of treatment. Although guidelines include many laboratory tests for diagnosis, these are not possible in many primary care centers. We aimed to identify the characteristics and the differences associated with its cause to develop a clinical prediction model. Adult subjects with chronic cough who completed both Korean version of the Leicester Cough Questionnaire (K-LCQ) and COugh Assessment Test (COAT) were enrolled. Clinical characteristics of each etiology were compared using features included in questionnaires. Decision tree models were built to classify the causes. A total of 246 subjects were included for analysis. Subjects with asthma including cough variant asthma (CVA) suffered from more severe cough in physical and psychological domains. Subjects with eosinophilic bronchitis (EB) presented less severe cough in physical domain. Those with gastro-esophageal reflux disease (GERD) displayed less severe cough in all 3 domains. In logistic regression, voice hoarseness was an independent feature of upper airway cough syndrome (UACS), whereas female sex, tiredness, and hypersensitivity to irritants were predictors of asthma/CVA; less hoarseness was a significant feature of EB, and feeling fed-up and hoarseness were less common characteristics of GERD. The decision tree was built to classify the causes and the accuracy was relatively high for both K-LCQ and COAT, except for UACS. Voice hoarseness, degree of tiredness, hypersensitivity to irritants and feeling fed-up are important features in determining the etiologies. The decision tree may further assists classifying the causes of chronic cough.

Narrative Review: how long should patients with cough variant asthma or non-asthmatic eosinophilic bronchitis be treated?

The causes of chronic cough can be categorized into eosinophilic and noneosinophilic disorders, and approximately 30% to 50% of people with chronic cough have eosinophilic airway inflammation, the presence of which can be confirmed by sputum eosinophilia or elevated exhaled nitric-oxide levels. Cough variant asthma (CVA) is a phenotype of asthma which lacks wheezing or dyspnea, and consistently one of the most common causes of chronic cough worldwide. CVA and non-asthmatic eosinophilic bronchitis (NAEB) shares common feature such as chronic dry cough, eosinophilic inflammation, and development of chronic airflow obstruction (CAO) and asthma in a subset of patients. The distinctive characteristic of these conditions is the presence of airway hyperresponsiveness in CVA but not in NAEB. Coughing is responsive to bronchodilators such as beta-agonists in CVA, but such feature has not been clarified in NAEB. Inhaled corticosteroids (ICSs) are the first-line treatment, and leukotriene receptor antagonists are also effective, in patients with both CVA and NAEB. This review will give an outline of clinical and physiological features, and prognosis and its determinants of CVA and EBNA. Further, the rationale and evidence, despite limited, for the need of long-term treatment will be discussed. The development of airway remodeling due to mechanical stress to the airways exerted by long-standing coughing will also be discussed.

Chronic cough in children

A chronic cough in children is defined in the British Thoracic Society guidelines as a cough of 8 weeks or more. The aetiology of a chronic cough in children differs from adult populations, due to decreased cough reflex control in children, differences in airway anatomy and physiology, and immunological and neurological maturation changes. The three most common causes of chronic cough in adults (asthma, gastro-oesophageal reflux, and upper airway cough syndrome) account for less than 10% of the causes in children. Thus, it is important to assess and manage chronic cough in children differently.

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

BackgroundChronic cough has many diverse causes, including common and uncommon causes. There are few comprehensive reports on rare causes of chronic cough. The purpose of this study is to determine the etiological distribution, clinical features, and diagnostic value of special examinations in patients with rare causes of chronic cough.MethodsA retrospective analysis of patients with chronic cough who underwent medical history taking, full examination, and etiological treatment over a 13-year period was conducted. Causes of chronic cough with a prevalence of less than 3% were defined as rare causes.ResultsA total of 1,554 patients were enrolled, and 39 causes of chronic cough were identified. Among them, 1,055 cases were due to common causes, whereas 235 cases were due to rare causes; the causes involved 7 bodily systems. The top five rare causes were protracted bacterial bronchitis, somatic cough syndrome, diffuse panbronchiolitis, obstructive sleep apnea syndrome (OSAS), and interstitial lung disease, accounting for 67.2% of all rare causes. Among 235 patients with rare causes, causes in 90 (38.3%) patients were detected by chest high-resolution computed tomography (HRCT), in 44 (18.7%) patients by bronchoscopy/nasopharyngoscopy, and in 21 (8.9%) patients by pulmonary spirometry and diffusing capacity testing.ConclusionsAmong the 31 rare causes of chronic cough in this cohort, the top five were protracted bacterial bronchitis, somatic cough syndrome, diffuse panbronchiolitis, OSAS, and interstitial lung disease. Special examinations, such as chest HRCT and bronchoscopy, should be considered after excluding common causes of chronic cough.

Managing bronchiectasis in adults in primary care: a clinical update.

Bronchiectasis is a condition where patients have symptoms of persistent or recurrent bronchial sepsis related to irreversibly damaged and dilated bronchi.1 The prevalence of bronchiectasis has risen by about 60% between 1994 and 2013 so that a GP practice population of 10 000 will have around 50 patients with the condition.2 Many patients with stable bronchiectasis and acute flare-ups can be managed in primary care. A diagnosis of bronchiectasis should be suspected when a patient presents with a recurrent or persistent (>8 weeks) cough with production of purulent or mucopurulent sputum.1 There should be a higher index of suspicion if there are coexistent factors, as outlined in Box 1. A full history and examination should be carried out to exclude other causes of chronic cough, such as chronic obstructive pulmonary disease (COPD), asthma, or lung cancer. Box 2 shows red-flag symptoms suggesting alternative serious pathology. | | || Box 1. Coexistent conditions raising the probability of bronchiectasis …

Giant ancient intercostal schwannoma: a rare cause of chronic cough and progressive dyspnoea.

Giant ancient intercostal schwannoma: a rare cause of chronic cough and progressive dyspnoea.

Characteristic appearance of the oropharynx in patients with postnasal drip (PND)-induced cough.

Post-nasal drip (PND)-induced cough is a common cause of chronic cough. However, there is little known about the characteristic physical findings of this condition. We investigated views of the pharyngeal wall in patients with PND-induced cough using a handy endoscopic images. The subjects were 135 consecutive patients referred to our hospital with a sensation of something "dripping down the throat" as one of their symptoms. Physical findings for the oropharynx were examined using Wi-Fi endoscope camera. The difference in probability of symptoms in patients with acute cough and those with subacute/chronic cough was assessed using a Bayesian Fisher exact test on a 2×2 table. Among the patients, 105 (78%) complained of cough, 78 (58%) of acute cough, 20 (15%) of subacute cough, and 7 (5%) of chronic cough; and 71 (53%) had coexisting asthma. Using Bayesian inference, a sore or scratchy throat and fever were more common in patients with acute cough than in those with subacute/chronic cough. In endoscopic images of the oropharynx, a reddish curtain sign on the posterior pharyngeal wall behind the palatopharyngeal arch was found in 121 patients (90%). Patients with acute PND-induced cough have a component of acute upper respiratory infection, because of high probability of a sore or scratchy throat and fever as symptom. A reddish curtain sign may be a useful finding for identifying PND-induced cough in these cases.

Mammomonogamus laryngeus: an unusual cause of acute and chronic cough in the Caribbean area.

Mammomonogamus is an unusual cause of chronic cough found in the Caribbean region. The region is very popular with tourists. There is interest in thinking about a cough that cannot be explained in any patient who has stayed in this region. https://bit.ly/3qnemv9

Limited Clinical Utility of Lipid-Laden Macrophage Index of Induced Sputum in Predicting Gastroesophageal Reflux-Related Cough.

Gastroesophageal reflux disease (GERD) is a common cause of chronic cough (CC). However, the diagnosis of GERD associated with CC based on 24-hour esophageal pH-monitoring or favorable response to empirical anti-reflux trials is invasive and time-consuming. Lipid-laden macrophages (LLMs) are supposed to be a biomarker for micro-aspiration of gastric content in the respiratory tract. This study was conducted to collect LLMs by the sputum induction technique and observe the relationship among the amount of LLMs, cough severity, parameters of 24-hour esophageal pH-monitoring and therapeutic response. The 24-hour esophageal pH-monitoring and sputum induction were performed on 57 patients with suspected GERD associated with CC. Thirty-four patients were followed up after empirical anti-reflux trials of 8 weeks to record the therapeutic response. Lipid-laden macrophage index (LLMI), a semiquantitative counting of LLMs, showed no significant correlation with the values of 24-hour esophageal pH monitoring at the proximal or remote electrode. No difference in LLMI or DeMeester score, as well as cough symptom association probability, were found between the responders and the non-responders. Reflux symptoms were more common in the responders (50%) compared to the non-responders (6%) (P < 0.05). Our study suggests that LLMI shows limited utility in clinically diagnosing GERD associated with CC as an underlying etiology or in predicting response to anti-reflux therapy. Anti-reflux therapy is more effective for CC patients with reflux symptoms than for those without.

Chronic cough in children – challenges

Introduction. Cough is the most common symptom for consultation with a family doctor in many European coun­tries. Its persistence for a long time affects the patient’s qua­li­ty of life. Case report. We present the case of a 13-year-old adolescent hospitalized for frequent, emitting, all day long, spastic cough started 7 months earlier and who did not recover from antibiotic and symptomatic treatment. The clinical examination of the respiratory tract was within nor­mal limits. Asthma, the most common cause of chronic cough in adolescents, was ruled out by spirometry and eva­lua­tion of athopy. Posteronasal drops have been also ruled out by ENT examination, and bronchoscopy and the de­ter­mi­na­tion of Quantiferon TB allowed the refutation of a pul­mo­nary tuberculosis, but also of foreign body aspiration. Up­per digestive endoscopy confirmed the presence of mi­ni­mal gastroesophageal reflux and identified a polypoid for­ma­tion with a broad base of implantation in the cardia, la­ter confirmed by thoracoabdominal CT and esogastric ba­rium transit. Under treatment with a proton pump inhibitor, the evo­lu­tion was favorable, with the remission of the polyp and of cough exacerbations. Conclusions. Chronic cough may be the single manifestation of gastroesophageal reflux po­ten­tia­ted by an inflammatory formation in the cardia.

Tracheal extramedullary plasmacytoma: a rare cause of chronic cough.

Operative Rigid Bronchoscopy treatment.

Causes of chronic cough in adolescent and adult patients.

Background: Adolescents differ from adults in certain aspects, but the differences in the etiology of chronic cough between adolescents and adults have not been specifically investigated. The purpose of this study is to evaluate the causes of chronic cough in adolescent patients in comparison with those in adult patients. Methods: The electronic medical records were retrospectively screened for patients with the initial diagnosis of chronic cough from 2016 to 2018. Clinical variables and the causes of chronic cough were collected in patients who met inclusion criteria. Patients were assigned to adolescent (13 to 18 years) and adult (> 18 years) group based on age. The distribution of causes of chronic cough was compared by t-test and χ2 tests between adolescent and adult groups using SPSS. Significant level was set at 0.05. Results: The enrolled patients consisted of 16 adolescents and 73 adults with chronic cough. The most common causes of chronic cough were cough-variant asthma and upper airway cough syndrome in both adolescents and adults. The frequency of post infectious cough in adolescents was significantly higher than that in adults (12.5% vs. 1.36%; p= 0.024). Although no significant difference between the two groups was found, there was a trend that suggested that habitual cough was more common in the adolescent group (6.25%:1.36%); while gastroesophageal reflux disease (GERD) did not show similar results (6.25%:20.54%). Conclusion: There are moderate differences in the causes of chronic cough between adolescent and adult patients. Realizing those differences would be helpful for clinicians to establish an appropriate differential diagnosis and make referral decisions.

Acute and chronic cough-What is new?

Häufigste Ursache des akuten (bis zu 3 Wochen Dauer) oder subakuten (3–8 Wochen) Hustens ist ein viraler Infekt, der bei ansonsten gesunden Personen meist spontan abklingt. Einige pflanzliche Kombinationspräparate, Ambroxol und das Antitussivum Dextromethorphan erleichtern den Husten und verkürzen dessen Dauer. Antibiotika haben keinen Einfluss auf die Symptome und sollten wegen der Resistenzentwicklung nicht gegeben werden. Kann die Ursache eines ≥8 Wochen anhaltenden Symptoms Husten nach entsprechender Diagnostik keiner etablierten Krankheit zugeordnet werden, handelt es sich um eine eigenständige Erkrankung, den chronischen idiopathischen (unerklärten) Husten (CIH). Bei den Betroffenen ist die Sensitivität des Hustenreflexes erhöht, der schon durch schwache, unterschwellige Einflüsse wie langes Sprechen, Temperaturänderung, Gerüche usw. ausgelöst wird. Bei Nichtansprechen auf die leitliniengerechte Therapie wird vom chronisch refraktären Husten gesprochen.

Methacholine-induced cough as an indicator of bronchodilator-responsive cough

BackgroundCough variant asthma (CVA) is the most common cause of chronic cough and responds well to bronchodilator therapy. Previous studies on methacholine -induced cough have shown that heightened cough response due to bronchoconstriction is a feature of CVA. The aim of this study was to assess Mch-induced cough as an indicator of bronchodilator-responsive cough (BRC). MethodsThis was a single-center retrospective study of prolonged/chronic cough cases who underwent evaluation via spirometry, FeNO and bronchial challenge testing using Mch and capsaicin (C5). Resultant bronchoconstriction after Mch challenge was assessed by flow-volume curves measuring the expiratory flow of the partial flow-volume curve 40% above residual volume (PEF40) and FEV1. BRC was defined as a decrease in cough with bronchodilator therapy by 30% or more on a visual analog scoring scale. ResultsOf the 100 patients evaluated, 63 were diagnosed with BRC. Mch-induced cough at a decrease in PEF40 of 35% (PC35-PEF40) was predictive of BRC on AUROC analysis with an AUC of 0.82 (95% CI 0.73–0.90) and cut-off of 24. The AUC for C5, FeNO and PC20-FEV1 were 0.65, 0.47, and 0.58, respectively. ConclusionCompared to C5, FeNO and PC20-FEV1, Mch-induced cough better supports a diagnosis of BRC.

ENDOBRONCHIAL HAMARTOMA: A RARE CAUSE OF WORSENING ASTHMA

SESSION TITLE: Fellows Procedures Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pulmonary Hamartomas have an incidence of 0.025-0.32% in the general population (1) and almost all are benign. Approximately 10% of them are endobronchial, and may present as refractory asthma. CASE PRESENTATION: A 46-year-old male with previously well controlled asthma, developed worsening respiratory symptoms including shortness of breath and wheezing over the past year. Despite good compliance, inhaler technique and up-titration of his asthma medications, his exacerbations became unpredictable and refractory to further medical therapy. Furthermore, he reported exertional dyspnea and persistent cough and denied sputa, weight loss, hemoptysis, or recent pneumonia. His physical exam revealed a mono-phasic wheeze on auscultation. Dyspnea workup included CT chest (Fig 1), which showed a right main stem endobronchial mass causing near-complete obstruction of the airway. He was referred to our hospital for resection of the mass. A rigid bronchoscopy was done under general anesthesia and a proximal right main bronchus lesion was noted protruding into the distal trachea (Fig 2). The bronchoscope bevel was advanced through the tumor base, with successful core-out of the 1.5cm tumor en bloc. Hemostasis was achieved from tamponade of the tumor base by the rigid scope and further bleeding was controlled with Argon Plasma Coagulation (APC). Post resection, the right bronchus was widely patent without any residual obstruction. He made a complete recovery with immediate post-op improvement in his breathing. Histopathology confirmed it to be a cartilaginous hamartoma (Fig 3). DISCUSSION: Pulmonary hamartomas are rare, benign tumors, originating from the bronchial primitive mesenchymal tissue, which differentiates into various mature components, such as cartilage, bone, fat and muscle tissue. To be classified as a hamartoma, two distinct mesenchymal components native to the organ must be present in a disorganized pattern. Generally, the cartilaginous component is predominant and is classified as a cartilaginous hamartoma. Endobronchial Hamartomas are asymptomatic, until they enlarge to cause bronchial obstruction. Clinical presentation includes persistent cough, dyspnea, wheezing, fever, sputum, hemoptysis or recurrent pneumonia. CT chest may provide a clue to diagnosis by the presence of high fat content in the mass, lack of contrast uptake or extra-bronchial invasion. Needle biopsy of the lesion is frequently inadequate or often misguiding if squamous metaplasia is present in the overlying epithelium. Endoscopic resection is the gold standard treatment. Traditional tracheotomy, wedge resection or lobectomy is reserved for non-resectable lesions or with underlying lung parenchymal damage with recurrence being extremely low. CONCLUSIONS: Endobronchial hamartomas may present as refractory asthma, and prompt evaluation can prevent recurrent hospitalizations, offer a cure and improve quality of life. Reference #1: Endobronchial hamartoma: a rare structural cause of chronic cough by Saman Ahmed et al. Respiratory Medicine Case Reports 22 (2017) 224e227 Reference #2: Endobronchial Hamartoma: literature search and case report. J.F. PATERSON. CHEST, November 1956. Reference #3: A Case Report of Endobronchial Hamartoma: surgical options for resection. Wen Xi. CHEST, April 2016, Vol149, Issue 4. DISCLOSURES: no disclosure on file for Fawad Chaudry; No relevant relationships by Maham Khan, source=Web Response No relevant relationships by Adam Przebinda, source=Web Response No relevant relationships by Aejaz Ul Haq, source=Web Response

Drug-induced chronic cough and the possible mechanism of action.

Chronic cough is defined as a cough lasting for ≥8 weeks with a normal chest radiograph. The common causes of chronic cough are cough variant asthma (CVA), upper airway cough syndrome/postnasal drip syndrome (UACS/PNDs), eosinophilic bronchitis (EB), gastroesophageal reflux-related chronic cough (GERC) and atopic cough (AC). Drug-induced chronic cough, a rare cause of chronic cough, refers to a chronic cough caused by certain drugs. In addition to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), there are cases reporting that some drugs such as omeprazole and leflumide that can cause cough. An important step in the diagnosis and treatment of chronic cough is to determine the history of the patient with regard to any drugs that can induce chronic cough. If the cough occurs after taking the medicine, a suspected diagnosis of drug-induced cough should be established. If the cough resolution occurs within 1 to 4 weeks after drug withdrawal, it would be considered as a side effect of the medication. we should be alert to the possibility of drug-induced chronic cough after excluding CVA, UACS, EB and other common causes of chronic cough. This article reviews the relevant drugs that may cause cough and their possible mechanisms of action.

Should computed tomography and bronchoscopy be routine examinations for chronic cough?

Chronic cough is a common symptom of many diseases. Guidelines on cough from different countries recommend chest X-ray as the first-line examination. However, as compared to computerized tomography (CT), chest X-ray is insensitive in the diagnosis of many diseases. We speculate that CT is more helpful in excluding the causes of long-term cough, such as bronchial tumors and pulmonary interstitial diseases, which prevents patients from receiving unnecessary examinations and diagnostic treatments for chronic cough. In addition, a single chest CT is safe and affordable in some regions. Therefore, chest CT may be recommended as a first-line examination for patients with chronic cough. In addition, although bronchoscopy is employed as a further examination for chronic cough, it plays an important role in the diagnosis of chronic cough, especially in rare bronchial diseases such as amyloidosis and foreign body inhalation. Induced sputum cytology was not accepted as a necessary examination for chronic cough, but it becomes a first-line examination until physicians recognize that non-asthmatic eosinophilic bronchitis is a common cause of chronic cough. Therefore, we speculate that the roles of chest CT and bronchoscopy in the identification of causes of chronic cough are increasingly important; in some regions, or for patients suspicious for uncommon causes of chronic cough, CT and bronchoscopy are recommended as first-line examinations.