Common Causes Of Chronic Cough Research Articles

Prevalence and risk factors for reflux esophagitis in patients with chronic obstructive pulmonary disease.

Background/AimsGastroesophageal reflux disease is one of the most common causes of chronic cough and is a potential risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the prevalence and risk factors for reflux esophagitis (RE) in COPD patients.MethodsFrom our hospital database, between September 2006 and April 2010, we searched for subjects who were 40 years old or older and had undergone both postbronchodilator spirometry and esophagogastroduodenoscopy (EGD). COPD was defined as having a ratio of forced expiratory volume in 1 second to forced vital capacity < 0.7 in postbronchodilator spirometry and no abnormality causing airway obstruction, except emphysematous changes, on a chest X-ray. The diagnosis of RE was based on a mucosal break surrounding the distal esophageal sphincter through EGD.ResultsIn total, 253 patients with COPD were enrolled. The prevalence of RE in COPD was 30% (76/253). Multiple logistic regression analyses revealed that age (odds ratio [OR], 0.950; 95% confidence interval [CI], 0.918 to 0.983; p = 0.003), smoking pack-years (OR, 1.015; 95% CI, 1.004 to 1.025; p = 0.006), and inhaled anticholinergics (OR, 0.516; 95% CI, 0.271 to 0.982; p = 0.044) were independently associated with RE in COPD patients.ConclusionsThe prevalence of RE in our COPD patients was higher than that reported previously in the Korean general population. In COPD, smoking increased the risk of RE, whereas inhaled anticholinergics may be associated with a reduced risk of RE.

S34 Management of chronic cough in primary care

BackgroundChronic cough is a common symptom in primary care. There appears to be significant variation in investigation and empirical treatment prior to referral on to secondary care. We looked at;...

Chronischer Husten

In non-smokers without intake of an ACE-inhibitor, the three most common causes of chronic cough are eosinophilic airways disease (asthma or eosinophilic bronchitis), Upper-airway-cough-syndrome (UACS) and Gastro-esophageal-reflux desease (GERD). In smokers, chronic bronchitis and COPD are common causes as well. In patients with a normal chest X-ray and lack of information on a less frequent cause in history and physical examination, it is recommended therefore to routinely look for these diseases and/or to treat them empirically.

Association between chronic obstructive pulmonary disease and gastroesophageal reflux disease: a national cross-sectional cohort study.

BackgroundGastroesophageal reflux disease (GERD) is one of the most common causes of chronic cough and a potential risk factor for exacerbation of chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the prevalence and risk factors of GERD in patients with COPD and association between GERD and COPD exacerbation.MethodsData were collected from the National Health Insurance Database of Korea. The subjects were 40 years old and older, who had COPD as primary or secondary diagnosis codes and utilized health care resource to receive prescriptions of COPD medication at least twice in 2009. Univariate logistic regression was performed to understand the relationship between COPD and GERD, and multiple logistic regression analysis was performed with adjustment for several confounding factors.ResultsThe prevalence of GERD in COPD patients was 28% (39,987/141,057). Old age, female gender, medical aid insurance type, hospitalization, and emergency room (ER) visit were associated with GERD. Most of COPD medications except inhaled muscarinic antagonists were associated with GERD. The logistic regression analysis showed that the presence of GERD was associated with increased risk of hospitalization (OR 1.54, CI 1.50 to 1.58, p<0.001) and frequent ER visits (OR 1.55, CI 1.48 to 1.62, p<0.001).ConclusionsThe prevalence of GERD in patients with COPD was high. Old age, female gender, medical aid insurance type, and many COPD medications except inhaled muscarinic antagonists were associated with GERD. The presence of GERD was associated with COPD exacerbation.

Epidemiology of cough in relation to China

Cough is one of the most common complaints for which patients seek medical attention. Misdiagnosis and mistreatment of cough exist commonly in China. The prevalence of acute cough caused by upper airway infection fluctuates between 9% and 64% in the community, for chronic cough, the prevalence >10% in most surveys, ranging from 7.2%-33%. The common causes of chronic cough are upper airway cough syndrome (previously called as post nasal drip syndrome [PNDS]), cough variant asthma (CVA), gastroesophageal reflux related cough (GERD) and eosinophilic bronchitis (EB). There is a regional discrepancy regarding the prevalence of common causes of cough and distribution of gender among China, UK, USA, the most common cause of chronic cough in China are CVA, followed by UACS, EB and atopic cough (AC), the male is almost equal to female in numbers in China. The risk factors for cough includes cold air, smoking, environmental pollutants, noxious substances and allergens, and unreasonable diet habits.

Air Pollution and Chronic Cough in China

Air Pollution and Chronic Cough in China

PTU-130 Does Chronic Cough Provoke Increased Gastro-Esophageal Reflux?

IntroductionChronic cough and GERD are very common and prevalent diseases. It is known that GERD is one of the three most common causes of chronic cough. During the last years,...

Tu1774 Does Chronic Cough Provoke Increased Gastro-Esophageal Reflux?

Introduction Chronic cough and GERD are very common and prevalent diseases. It is known that GERD is one of the three most common causes of chronic cough. During the last years, new methods have been introduced to study the temporal and causal association between reflux and cough. pH-impedance monitoring has been proposed as the most sensitive method for detection of acid and non acid reflux whereas either manometric or acoustic methods have been used for objective detection of cough. During these studies, a sequence of association of “reflux-cough” has been used to establish a positive diagnosis. The sequence cough-reflux has also been described but controversy still exist about its prevalence and clinical relevance. One potential factor for such controversy could be due to different methodology for cough detection. The aim of this study was to assess the contribution of cough to pathologic GER in patients with chronic cough and increased esophageal acid exposure. Methods Simultaneous 24h ambulatory reflux and cough monitoring was performed in 17 patients with suspected reflux-related chronic cough. Reflux episodes were detected by pH-impedance monitoring and coughs by a) manometric detection and b) acoustic detection (independent listening of complete 24hs sound recordings). Manometric cough detection was performed with a two-channel pressure catheter with sensors in the oesophagus and stomach. Cough was manually declared when simultaneous abdomino-thoracic pressure bursts occurred of at least 2 peaks within 3 seconds. Acoustic detection was performed using 3 sound surface sensors. Cough events were identified and inserted into the reflux tracing. We measured total esophageal acid exposure and bolus exposure (by impedance). We calculated the time of acid exposure and bolus exposure after manometrically and acoustic detected cough events. Results 6/17 patients had pathological esophageal acid exposure. In these patients the total number of reflux events/24hs was 38 (29–70). From that total number, 7.4% (0–25) reflux episodes occurred within 2 minutes after a cough episodes. Total acid exposure was 9.7% ± 4.7. From the acid exposure, 3.5% (0- 8)% occurred after cough detected by manometry or audio. The median total bolus exposure was 2.1 ± 0.6%. From total bolus exposure, 6.3% (0–20) occurred after manometric cough detection and 6.8% (0–50) after acoustic detected cough. Only 1/6 patients had a significant increase in acid and bolus exposure after cough. Conclusion In patients with chronic cough and pathological acid GER, cough was followed by reflux in a minority of cases regardless of the method for cough detection. In only 1/6 patients the sequence cough-reflux could be considered as causal of pathological GER. Disclosure of Interest None Declared

A Prospective, Multicenter Survey on Causes of Chronic Cough in China

The causes of chronic cough in China and its relations with geography, seasonality, age, and sex are largely uncertain. A prospective, multicenter survey was conducted to evaluate patients with chronic cough across five regions in China by using a modified diagnostic algorithm. The effects of geography, seasonality, age, and sex on spectrum of chronic cough were also investigated. The current study evaluated 704 adult patients, including 315 men (44.7%) and 389 women (55.3%). The causes of chronic cough were determined in 640 subjects (90.9%). Common causes included cough variant asthma (CVA) (32.6%), upper airway cough syndrome (UACS) (18.6%), eosinophilic bronchitis (EB) (17.2%), and atopic cough (AC) (13.2%). Collectively, these four causes accounted for 75.2% to 87.6% across five different regions without significant difference (P &gt; .05), although there was variation on single causes. Gastroesophageal reflux-related cough was identified in 4.6% of causes. Seasonality, sex, and age were not associated with the spectrum of chronic cough (all P &gt; .05). CVA, UACS, EB, and AC were common causes of chronic cough in China. Geography, seasonality, age, and sex were not associated with the spectrum of chronic cough.

Classification of chronic cough by systematic treatment cascade trial starting with beta agonist

BackgroundChronic cough is one of the most challenging symptoms to diagnose and treat, not only because of the variety of underlying disorders but also its varying susceptibility to treatments. Etiological studies of chronic cough vary depending on the clinical settings and the particular interests of investigators.ObjectivesThe purposes of this study were first to categorize the etiology of chronic cough by its response to systematic diagnostic treatments starting from the β2 agonist and second to sub-categorize β2 agonist responsive cough (BRC) by the airway hyperresponsiveness.MethodsOne hundred and eighty-four never-smokers received the maximal dose of procaterol to diagnose BRC. BRC was sub-categorized into two groups with or without airway hyperresponsiveness measured by the methacholine challenge test. Sinobronchial syndrome (SBS) was diagnosed by postnasal drip symptoms and by the response to clarythromycin and carbocysteine. Atopic cough (AC) was diagnosed by the evidence of atopy and the response to cetirizine hydrochloride. Gastroesophageal reflux disease (GERD) was diagnosed by the response to rabeprazole sodium. Since we did not investigate eosinophil counts in the tissue or in the induced sputum, no diagnosis of eosinophilic bronchitis was made.ResultsOne hundred and nine patients had BRC. Twenty-three of them had bronchial asthma (BA), 53 had cough variant asthma (CVA) and 33 had non-hyperresponsive BRC (NHBRC). Thirty-one patients had GERD, 27 had AC and 14 had SBS. Twenty-five patients had more than one diagnosis in combination, while 6 had other miscellaneous diseases. Twelve patients were undiagnosed and 11 dropped out of the study.ConclusionsThe majority of chronic cough was BRC. NHBRC was a new chronic cough entity. GERD is a common cause of chronic cough in Japan, as in Western countries. AC and SBS are also causes of chronic cough in Japan.Trial registrationUniversity hospital medical information network (UMIN 000007483)

Rhinitis, sinusitis and ocular disease – 2087. Usefulness of impulse oscilometry and fractional exhaled nitric oxide in children with eosinophilic bronchitis

Background Eosinophilic bronchitis (EB) is a common cause of chronic cough. Although EB shares many immunopathologic features with asthma, it does not show airway hyperresponsiveness or reversible airway obstruction by spirometry. Compared to healthy children without pulmonary disease, we hypothesized that EB patients would demonstrate abnormal pulmonary function and inflammation with impulse oscillometry (IOS) and fractional exhaled nitric oxide (FeNO), which are more sensitive tests of these parameters than spirometry.

The oesophagus and cough: laryngo-pharyngeal reflux, microaspiration and vagal reflexes

Gastro-oesophageal reflux disease is generally considered to be one of the commonest causes of chronic cough, however randomised controlled trials of proton pump inhibitors have often failed to support this notion. This article reviews the most recent studies investigating the mechanisms thought to link reflux and cough, namely laryngo-pharyngeal reflux, micro-aspiration and neuronal cross-organ sensitisation. How recent evidence might shed light on the failure of acid suppressing therapies and suggest new approaches to treating reflux related cough are also discussed.

Dietary intervention in the treatment of patients with cough and symptoms suggestive of airways reflux as determined by Hull airways Reflux Questionnaire.

BackgroundChronic cough is a common and distressing symptom. Gastro-oesophageal reflux is a common cause of chronic cough however the symptom complex in cough is not confined to classic peptic symptoms. Dyspeptic symptoms have previously been shown to respond to dietary modifications and weight loss. We hypothesised that weight reduction maybe a useful non-pharmacological strategy in reducing reflux cough in the obese.MethodsSubjects with cough were recruited from Hull Cough Clinic. They were randomised to one of two open parallel groups; one receiving the traditional dietary modifications and the other weight reduction advice in the form of an Energy Prescription (EP). Cough symptoms, using the Leicester cough questionnaire (LCQ) and dietary intake were measured at the start and end of the study.ResultsThirty-three patients were recruited and 20 patients completed the study. Mean weight loss was 3.1 kg (p < 0.001) and reported an improvement in the LCQ (mean improvement 3.1); which is greater than the clinically significant score of 1.3. . Moreover, secondary outcomes showed a significant association between baseline high calorie (r = -0.24; p < 0.001) and fat intake (r = -0.36; p = 0.001), and LCQ scores.ConclusionA high calorie and fat intake is strongly correlated with cough score. Irrespective of diet, weight loss is associated with a reduction in cough symptoms. Asking patients to lose weight by reducing fat and calorie intake may be a simple strategy to ameliorate this intractable condition.Trial RegistrationThe study was approved by the local research ethics committee (South Humber Local Research Ethics Committee; REC04/Q1105/62). The study was registered with the Research and Development Department, Clinical Governance Directorate, Hull and East Yorkshire Hospitals NHS Trust (reference number R0086).

Successful resolution of refractory chronic cough induced by gastroesophageal reflux with treatment of baclofen

Gastroesophageal reflux induced cough is a common cause of chronic cough, and proton pump inhibitors are a standard therapy. However, the patients unresponsive to the standard therapy are difficult to treat and remain a challenge to doctors. Here, we summarized the experience of successful resolution of refractory chronic cough due to gastroesophageal reflux with baclofen in three patients. It is concluded that baclofen may be a viable option for gastroesophageal reflux induced cough unresponsive to proton pump inhibitor therapy.

Posterior laryngitis: a study of persisting symptoms and health-related quality of life

Posterior laryngitis is a common cause of chronic cough, hoarseness, voice fatigue and throat pain. The aim of the present study was to examine how patients with posterior laryngitis have been examined, treated and followed up, and to assess their present health-related quality of life (HRQOL). Patients treated for posterior laryngitis at consultation at the ear-, nose- and throat clinic during 2000-2008 were contacted by mail. The letter contained questionnaires addressing the current symptoms and medication, and the HRQOL 36-item short-form questionnaire (SF-36). Medical records were scrutinized. One hundred and twenty-two patients with verified signs and symptoms of posterior laryngitis were included. Forty percent of the patients had been treated for acid-related symptoms prior to consultation. The most common symptoms at the time of consultation were the sensation of hoarseness (women 40 %, men 37 %), globus (women 35 %, men 33 %) and cough (women 33 %, men 26 %). The most frequent diagnosis was gastro-oesophageal reflux disease. Ninety percent of the women and 92 % of the men were treated with proton pump inhibitors (PPIs). At the time of study, 63 % of the patients still had symptoms. The results of the SF-36 questionnaire showed significantly lower HRQOL for women. Patients with posterior laryngitis present varying symptoms, and are often not adequately treated or followed up. When PPI treatment fails, other aetiologies of their complaints, such as visceral hypersensitivity, weakly gaseous acid reflux or non-acid reflux are not considered. Symptoms from posterior laryngitis have a negative impact on the HRQOL for women.

Diagnosis and treatment of chronic cough in China: an insight into the status quo.

Chronic cough is a very common complaint in clinics throughout China. Clinical and basic science research on chronic cough started late, but in recent years the effort has yielded promising findings regarding the etiological diagnosis, treatment and pathogenesis. We found that inflammation in nonasthmatic eosinophilic bronchitis has some similarities to cough variant asthma but also a number of distinct differences. Recent evidence has also suggested a mechanistic link between airway neurogenic inflammation and and gastroesophageal reflux cough (GERC). Cough-related animal models have been developed, including models for esophageal reflux, nonasthmatic eosinophilic bronchitis and allergic rhinitis. Normal reference values for differential cell counts in induced sputum, cough sensitivity and esophageal 24-h pH monitoring in Chinese healthy subjects have been established. By using a modified algorithm for the etiological diagnosis of chronic cough, the causes of chronic cough have been investigated across a number of cities in China. The most common causes of chronic cough are cough variant asthma, eosinophilic bronchitis, upper airway cough symptoms, atopic cough and GERC, however, there are some regional variations. The Chinese National Guidelines on Diagnosis and Management of Chronic Cough were drafted in 2005, updated in 2009, and have been widely publicized and disseminated through many channels since their publication.

Usefulness of impulse oscillometry and fractional exhaled nitric oxide in children with Eosinophilic bronchitis

Eosinophilic bronchitis (EB) is a common cause of chronic cough. Although EB shares many immunopathologic features with asthma, it does not show airway hyperresponsiveness or reversible airway obstruction by spirometry. Compared to healthy children without pulmonary disease, we hypothesized that EB patients would demonstrate abnormal pulmonary function and inflammation with impulse oscillometry (IOS) and fractional exhaled nitric oxide (FeNO), which are more sensitive tests of these parameters than spirometry. A total of 232 children with asthma, 109 with EB, and 115 control subjects were enrolled. We compared pulmonary function parameters and FeNO levels among the three groups. Additionally, we designated a screening cutoff value of FeNO combined with IOS parameters to distinguish EB from the control group, and identify which children with EB have more asthmatic characteristics. By IOS, the bronchodilator response of the EB and asthma groups increased significantly compared to controls for both reactance at 5 Hz (Δ X5) and reactance area (Δ AX) (P < 0.0001). Cutoff values to distinguish EB from controls were a Δ X5 of -20% (sensitivity, 77.5%; specificity, 49.6%), and Δ AX of -30% (sensitivity, 75.0%; specificity, 46.0%), when the FeNO is 20 ppb. Reversible airway obstruction in IOS and elevated FeNO levels can be detected in children with EB. This would support that EB in children shows airway characteristics similar to those of asthma, and that a continuum exists between asthma and EB.

Przewlekły kaszel w praktyce otorynolaryngologicznej

Cough is the most common symptom of the upper and lower airway diseases. In its nature, cough is a defence reflex mechanism of the respiratory tract that is used to clear the upper airways. Persistent cough is associated with a whole range of conditions, both respiratory and non-respiratory disorders. Chronic cough, defined as cough lasting for more than 8 weeks, is reported by 3–40% if the general population and has an important impact on patients' quality of life. In non-smokers upper airways cough syndrome, previously referred to as post nasal drip syndrome is one of the most common causes of chronic cough with asthma and gastroesophageal reflux. Chronic cough in majority of cases is related to more than one disease. The pathogenesis of cough from UACS remains unclear, but some authors indicate, that extrathoracic airway hyperresponsiveness – EAHR could be the responible mechanism. Chronic cough can present difficulties in diagnosis and management. Otorhinolaryngological assessment seems to be necessary component of diagnostic proccess, particularly in non-smoking, not-treated with ACEinhibitors adults with normal chest radiogram and excluded lower airways pathology. ENT approach in chronic cough could based on: ENT medical history and ENT examination, sinus CT scans, videolaryngoscopy, acoustic rhinometry, rhinomanometry, nasal cytology and nasal-sinus endoscopy. Such complex diagnostic tools, included otorhinolaryngological procedures, in many cases are necessary to recognized the cause of chronic cough and to establishe the accurate diagnosis, which implies a higher chance to effective treatment.

As a rare cause of drug-induced cough: topiramate

The most common causes of chronic cough in nonsmokers are postnasal drip syndrome, asthma, and gastroesophageal reflux disease. Drugs are also important in the etiology of resistant cough. Most common drugs inducing cough are the ACE inhibitors. Many drugs other than ACE inhibitors can also cause dry cough and one among them is topiramate. It is a new generation, efficacy-proved antiepileptic drug that is used widely for migraine prophylaxis in many countries. Most common adverse events of topiramate are paresthesia, cognitive symptoms, fatigue, insomnia, nausea, loss of apetite, anxiety, and dizziness. There is only one case report about topiramate associated cough in the literature. The present report refers to a patient, presenting with cough who is on topiramate treatment for migraine prophylaxis.

327 Transition from Cough Variant Asthma to Asthma With Reduced FEV1

BackgroundCough variant asthma (CVA) is one of the most common causes of chronic cough. It may have been thought to be as a pre-asthmatic condition. Some CVA patients show decreased lung function after diagnosed as a CVA. This study aimed to see differences of clinical characteristics between CVA with preserved FEV1 and CVA with reduced FEV1 after diagnosis of CVA.MethodsWe searched medical records from January 2007 to May 2011. Thousand six hundred sixty two patients were diagnosed as CVA. Among 1662 CVA patients, 284 patients were revisited to hospital with symptom of chest tightness.ResultsAmong 284, fifty two (18.3%) patients showed reduced FEV1. Mean interval between diagnosis of CVA and reducing of FEV1 was 305.5 days. There was no significant difference of level of PC20 or other pulmonary functional values between FEV1-reduced group and -preserved group.ConclusionsOnly small portion of CVA patients was transformed to asthma with reduced FEV1, and most of CVA still preserved their lung function.