Common Causes Of Chronic Cough Research Articles

Current aspects of differential diagnosis and treatment of cough

Cough is a common and important respiratory symptom that can cause significant complications for patients and be a diagnostic challenge for physicians. An organized approach to the evaluation of cough begins with classifying it as acute, subacute, or chronic based on duration and time of onset. Acute cough (up to 3 weeks) is most often one of the main symptoms of acute respiratory viral infections and acute bronchitis. Subacute cough, lasting from 3 to 8 weeks, is usually postinfectious postviral in origin. Common causes of chronic cough lasting more than 8 weeks with a normal chest X-ray are cough variant of bronchial asthma, chronic obstructive pulmonary disease, upper airway cough syndrome / postnasal drip syndrome, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux, and medications (primarily angiotensin-converting enzyme inhibitors). The spectrum of possible causes of cough is diverse, however, respiratory pathology comes to the forefront in the differential diagnostic search. Successful treatment of cough is an important task in clinical practice. Given the possible multicomponent nature of cough, the presence of catarrhal-respiratory and broncho-obstructive syndromes in the clinical picture along with bronchitis syndrome, combination drugs become the drug of choice. In conclusion, the possibilities of a combined (bromhexine + guaifenesin + salbutamol) expectorant against cough, its effectiveness and safety are considered.

The extract from Quzhou Aurantii Fructus attenuates cough variant asthma through inhibiting the TRPV1/Ca2+/NFAT/TSLP pathway and ferroptosis via TRPV1 mediation in ovalbumin-induced mice

Ethnopharmacological relevanceCough variant asthma (CVA), a prevalent chronic inflammatory disease, is the most common cause of chronic cough. Over the years, the aqueous extract of Quzhou Aurantii Fructus (QAFA) has been widely used to treat respiratory diseases, particularly cough. Aim of the studyThis study aimed to elucidate the therapeutic effect of QAFA on allergen-induced CVA, providing deep insights into the underlying mechanisms. Materials and methodsUltra-high performance liquid chromatography quadrupole time-of-flight mass spectrometry (UPLC–Q-TOF–MS) was employed to characterize the compositions, while UPLC was used to quantify the contents of its major components in QAFA. CVA model was established via sensitization and atomization with ovalbumin (OVA), and received 600 and 1200 mg/kg of QAFA via intragastric gavage. Cough response was assessed by stimulation with capsaicin (CAP). Then, airway hyperresponsiveness (AHR), ELISA, western blotting, RT-qPCR, and histological analyses, were applied to assess pulmonary function, pathological changes, and investigate mechanisms in CVA mice following QAFA treatment through the TRPV1/Ca2+-dependent NFAT-induced expression of TSLP and ferroptosis. Additionally, the effects and mechanisms of QAFA were validated using IL-4, CAP for stimulation, capsazepine (CPZ) for inhibition, and TRPV1 siRNA transfection in cells. ResultsChemical analysis revealed that QAFA primarily contained sixteen compounds, with four main components including narirutin, naringin, hesperidin, and neohesperidin. In vivo, QAFA treatment alleviated cough and AHR, while concurrently reducing airway inflammation and mucus secretion in CVA mice. These effects were achieved by suppressing the TRPV1/NFAT/TSLP pathway and modulating the expression of ferroptosis-related proteins. In vitro, siTRPV1-transfected BEAS-2B cells demonstrated the involvement of the TRPV1 channel in IL-4-mediated Ca2+ influxes, ferroptosis, and regulation of TSLP production. QAFA and CPZ suppressed IL-4-induced TSLP production via the TRPV1/NFAT pathway and regulated the levels of ferroptosis-related proteins, while CAP counteracted the effect of QAFA on TSLP production in BEAS-2B cells. Furthermore, QAFA reduced IL-4 or CAP induced Ca2+ influx and IL-4 induced ferroptosis through TRPV1 mediation. ConclusionsThis study demonstrated that QAFA improved pulmonary function and alleviated asthmatic inflammatory response in treating CVA probably through suppressing the TRPV1/Ca2+/NFAT/TSLP pathway and ferroptosis via TRPV1 mediation.

The Relationship Between Chronic Cough and Laryngopharyngeal Reflux: A Professional Voice User’s Guide on Diagnosis and Treatment

Abstract: Chronic cough is multifactorial in origin, affects quality of life adversely, including preventing singers from performing, and poses a diagnostic challenge. Laryngopharyngeal reflux (LPR) is one common cause of chronic cough, but there are many causes of which singing teachers should be aware. Recently, research has been completed to investigate the relationship between chronic cough and LPR to help with treatment and management of this complicated disease process, and that new information is summarized; but awareness of other causes is stressed because many physicians are not expert in cough management. Singers and teachers need to be informed health care consumers.

Nosological Pattern of Diseases Accompanied by Chronic Cough in Dogs

Introduction. A practicing veterinarian usually faces difficulties in both diagnosing and treating coughing in dogs. The unsolved problem in diagnosing entails doubts in the efficacy of the prescribed therapy. This is especially relevant for small dog breeds of middle and old age that often suffer from the chronic respiratory diseases and mitral insufficiency due to endocardiosis, and each of these diseases can lead to chronic cough. The aim of the research is to reveal the nosological pattern of the diseases accompanied by chronic cough in dogs.Materials and Methods. The research was based on the analysis of the medical records of 145 dogs with chronic cough that have attended to the network of veterinary clinics “Vita” (Rostov region) in the period from September 1, 2021 to July 31, 2024. The research was carried out using the following equipment: Karl Storz video bronchoscope (PAL colour system, working channel 2.3 mm, gaze direction 0°, aperture angle 120°, up/down deviation 180°/100°, depth of field 3–50 mm, working length 61 cm, outer diameter 6.2 mm); premium ultrasound scanner with improved image quality on the ZST+Mindray Vetus 9 platform; Maxivet 400 veterinary X-ray digital DR system; Poli-Spectrum–8/B computerassisted electrocardiograph; automatic hematology analyzer Idexx ProCyte Dx; automatic biochemistry analyzer Idexx Catalyst One; digital microscope Celestron.Results. The conducted research allowed us to find out the main causes of coughing in dogs. The most common cause of chronic cough found in these animals was chronic bronchitis, including that occurring simultaneously with the collapse of the upper respiratory tract. The rarest revealed cause of chronic cough was endocardiosis.Discussion and Conclusion. Coughing in dogs is not a characteristic sign of endocardiosis: even when the disease was clinically evident, coughing was observed only in the cases of lung congestion and interstitial pulmonary edema. As a rule, dogs with endocardiosis that have a pronounced loud cough intensifying after exertion, have a concomitant disease of the upper respiratory tract. Coughing in dogs with endocardiosis and upper respiratory tract lesion does not go away upon getting merely a specific endocardiosis treatment.

493. EFFECTIVENESS OF TRANSORAL INCISIONLESS FUNDOPLICATION (TIF) WITHOUT OR WITH HIATAL HERNIA REPAIR (CTIF) IN PATIENTS WITH GERD AND CHRONIC COUGH

Abstract Background GERD is a common cause of chronic cough. Although barrier therapy with laparoscopic fundoplication is highly effective for typical GERD symptoms, the response rates are variable for chronic cough. We hypothesized that transoral incisionless fundoplication (TIF) or TIF with hiatal hernia repair (cTIF) may be a suitable alternative for medically refractory cough associated with GERD. Aim We prospectively s studied the effectiveness and safety of TIF/cTIF in patients with chronic cough and proven GERD. Methods Patients with GERD and extra-esophageal symptoms from 10 academic and community medical centers (TIF Registry), elevated GERD-HRQL score +/- Reflux Symptom Index (RSI) >13 and pathologic reflux by esophageal pH-metry, or erosive esophagitis/Barrett’s esophagus were evaluated before and after a minimum 6 months post TIF/cTIF performed by gastroenterologists and surgeons. Patients with history of prior foregut/bariatric surgery, chronic obstructive or interstitial lung disease, or prior lung transplant were excluded. The primary outcome was improvement in RSI score at last follow-up compared to baseline. Secondary outcomes were: 1) normalization of RSI (<13), 2) improvement in cough sub-scores of RSI (decrease ≥ 2 points or to 0 on a 5-point scale), 3) GERD symptom improvement (>50% decrease in GERD-HRQL, or < 2 in all sub-scores) 4) discontinuation of proton pump inhibitor (PPI), and 5) overall patient satisfaction. We further analyzed response in patients with cough-predominant phenotype (chief complaint of cough and RSI troublesome cough subscore ≥2). Results 198 patients with cough and GERD successfully underwent TIF/cTIF (Table 1) without serious adverse events. Greater than 6-month follow-up was available for 177 patients at a median of 12 months [IQR 6,12]. Median RSI score decreased from 18 [IQR 13, 27] to 5 [IQR 2, 11] (p < 0.0001), median change 11 [IQR5,11]. 83% of patients with elevated baseline RSI normalized their scores. 75% of patients had improvement of cough when lying down (median: 1 point [IQR 0,3]), and 72% of patients had improvement of troublesome cough (median: 1 point [IQR 1,3]). 83% of patients successfully discontinued or decreased PPI to occasional use. Patient satisfaction improved from a baseline of 5.6% to 68.8% (p <0.0001). Compared to patients without cough-predominant symptoms, cough-predominant patients (n=108) experienced an additional 4.2-point decrease in in RSI score (p = 0.01) and 1.5-point decrease in troublesome cough sub-scores (p<0.0001). Patients with regurgitation phenotype were more likely to have a favorable cough response at 6 months (p<0.0001). In appropriately selected patients, cTIF and TIF were comparable for cough, GERD-HRQL, RSI, and PPI responses. Conclusion TIF/cTIF are effective and safe alternative barrier therapies for patients with pH-positive cough-predominant GERD.

Chronic cough diagnosis, treatment, and referral practices among family physicians in the United States: a survey study

BackgroundCough is one of the most common presenting problems for patients in primary care and is largely managed in primary care clinical settings. Family physicians’ familiarity with chronic cough guidelines and the extent to which these guidelines translate into everyday practice have not been well described. The objective of this study was to characterize current diagnosis, treatment, and referral practices among family physicians and to identify potentially impactful strategies to optimize chronic cough management in primary care.MethodsWe conducted a cross-sectional survey of 5,000 family physicians to explore diagnosis, treatment, and referral practices related to chronic cough management in adults in primary care. Respondents completed the survey via paper or online. The outcome measures were self-reported numeric ratings and responses related to the survey elements.Results588 surveys were completed (11.8% response rate). About half (49.6%) of respondents defined chronic cough in a manner consistent with the American College of Chest Physicians (ACCP) chronic cough guidelines, with the rest differing in opinion primarily regarding duration of symptom presentation. Respondents reported trying to rule out most common causes of chronic cough themselves before referring (mean 3.41 on a 4-point scale where 4 is “describes me completely”) and indicated a desire for more resources to help them manage and treat chronic cough. Years in practice and rural/urban setting influenced diagnosis and referral practices.ConclusionsFamily physicians see chronic cough as a complicated condition that can be and is often diagnosed and treated entirely in a primary care setting. They also value the ability to refer in complex cases. Our results support that family physicians provide evidence-based management of chronic cough.

Well-Established and Traditional Use of Vegetal Extracts as an Approach to the "Deep Roots" of Cough.

Cough is a common presenting symptom for patients in a primary care setting and significantly impacts a patient's quality of life. Cough involves a complex reflex arc beginning with the stimulation of sensory nerves that function as cough receptors that stimulate the cough center in the brain. This "cough center" functions to receive these impulses and produce a cough by activating efferent nervous pathways to the diaphragm and laryngeal, thoracic, and abdominal musculature. Drugs that suppress the neural activity of cough are non-specific as those treatments are not directed toward pathogenic causes such as inflammation and oxidative stress. Moreover, they block a reflex called the watchdog of the lung and have a defense mechanism. Acute respiratory infections of the upper and lower airways most commonly cause acute cough. In contrast, the most common causes of chronic cough are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, all associated with an inflammatory reaction at the level of the cough receptors. The use of natural compounds or herbal drugs such as carob syrup, dry blackcurrant extract, dry extract of caraway fruit, dry extract of ginger rhizome, dry extract of marshmallow root, and dry extract of ivy leaves, to name a few, not only have anti-inflammatory and antioxidant activity, but also act as antimicrobials, bronchial muscle relaxants, and increase gastric motility and empty. For these reasons, these natural substances are widely used to control cough at its deep roots (i.e., contrasting its causes and not inhibiting the arch reflex). With this approach, the lung watchdog is not put to sleep, as with peripheral or central inhibition of the cough reflex, and by contrasting the causes, we may control cough that viruses use at self-advantage to increase transmission.

Impulse oscillometry in the diagnosis of cough variant asthma in children

BackgroundCough variant asthma (CVA) is one of the most common causes of chronic cough in children worldwide. The diagnosis of CVA in children remains challenging. This study aimed to assess the diagnostic utility of impulse oscillometry (IOS) pulmonary function in children with CVA.MethodsThis study included children aged 4 to 12 years diagnosed with CVA who underwent IOS pulmonary function and bronchodilation (BD) tests. A control group of healthy children was matched. Pre- and post-BD IOS parameters were recorded and presented as mean ± standard deviation or median. Receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC) was calculated to evaluate the discriminatory potential of the IOS parameters for diagnosing CVA.ResultsA total of 180 patients with CVA and 65 control subjects were included. The baseline IOS parameters in the CVA group, except X5%pred, were significantly greater compared to the control group. After inhalation of salbutamol sulfate, all IOS parameters improved significantly in the CVA group. However, Z5%pred, R5%pred, and R20%pred remained greater in the CVA group compared to the control group. The improvement rates of IOS parameters in the CVA group significantly surpassed those in the control group. The ROC curve results for pre-BD IOS parameters and the improvement rate during the BD test showed that the combinations of pre-Z5%pred+△Z5% and pre-R5%pred+△R5% achieved the highest AUC value of 0.920 and 0.898, respectively. The AUC values of these combined parameters surpassed those of individual ones.ConclusionsThis study highlights that children with CVA exhibit greater IOS parameters compared to healthy children. The changes in IOS parameters during the BD test provided valuable diagnostic information for CVA, and the combination of various parameters can help pediatricians accurately identify CVA in children.

Efficacy, Safety and Economic Evaluation of Wolbigachul-Tang for Chronic Cough Due to Upper Airway Cough Syndrome (UACS): A Study Protocol for Randomized, Double-Blind, Active-Comparator Controlled, Parallel, Exploratory Clinical Trial.

Upper airway cough syndrome (UACS) is a common cause of chronic cough characterized by upper airway symptoms, including nasal discharge and throat discomfort. Empirical treatments for UASC-induced chronic cough, such as first-generation antihistamines, have been used; however, the long-term use of these medicines has adverse effects. Therefore, we evaluate the efficacy, safety, and economic feasibility of Wolbigachul-tang (WBGCT), an herbal medication for UASC-induced chronic cough. This is a randomized, double-blind, active-comparator-controlled, parallel, and exploratory clinical trial. Thirty patients with UASC-induced chronic cough will be recruited and randomly allocated to the WBGCT and control groups in a 1:1 allocation ratio. The investigational medicine will be administered three times per day for 2 weeks (3 g of WBGCT at a time). The primary outcome measure is the cough symptom score measured at screening, before starting the trial, and after 2 and 4 weeks. Secondary outcome measures include the cough visual analog scale, nasal discharge score, questionnaire of clinical symptoms of cough and sputum, Leicester cough questionnaire-Korean version, integrative medicine outcome scale, integrative medicine patient satisfaction scale, and 5-level EuroQol 5-dimensional questionnaire, which will be assessed before starting the trial and after 2 and 4 weeks. This study aims to investigate the efficacy, safety, and economic feasibility of WBGCT in the treatment of chronic cough. Therefore, the results of this trial provide evidence for the application of WBGCT in the treatment of UACS-induced chronic cough.

Surgical treatment of gastroesophageal reflux-related cough

Gastroesophageal reflux-related cough (GERC) is an extra-esophageal manifestation of gastroesophageal reflux disease (GERD) and a common cause of chronic cough. GERC is the most difficult of the chronic cough to diagnose and treat because of its lack of specificity and its multidisciplinary nature. In recent years, research into GERC has led to a consensus on many key issues. The 2021 edition of the Guidelines for the Diagnosis and Treatment of Cough (Cough guidelines) provides important guidance on the diagnosis and treatment of GERC. However, the surgical treatment of GERC is not well covered in the Cough guidelines. This article summarizes the surgical treatment of GERC in terms of surgical methods, current situation, indications for operation and curative effects.

Zi-Su-Zi decoction improves airway hyperresponsiveness in cough-variant asthma rat model through PI3K/AKT1/mTOR, JAK2/STAT3 and HIF-1α/NF-κB signaling pathways

Ethnopharmacological relevanceCough-variant asthma (CVA) is one of the most common causes of chronic cough. Its pathogenesis is closely related to chronic airway inflammation and airway hyperresponsiveness. CVA belongs to the category of “wind cough” in Traditional Chinese medicine (TCM). Zi-Su-Zi decoction (ZSD) is a Chinese herbal formula that is clinically used for the treatment of cough and asthma, especially CVA. However, the mechanism of action remains unclear. Aim of the studyIn this study, we aimed to explore the potential mechanism by which ZSD improves CVA airway hyperresponsiveness. Materials and methodsThe targets of ZSD in CVA were studied using a Network pharmacology. The main chemical components of ZSD were detected and analyzed using ultra-high-pressure liquid chromatography (UHPLC-MS/MS). In animal experiments, the rat model of CVA was established using Ovalbumin (OVA)/Aluminum hydroxide (AL(OH)3) sensitization. Moreover, the experiment also evaluated cough symptoms, percentage of eosinophils (EOS%), pulmonary function tests, histopathological sections, blood cytokine levels, mRNA and protein levels. ResultsThe results showed that Network pharmacology suggested 276 targets of ZSD and CVA and found that ZSD treatment with CVA was closely related to the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway. UHPLC-MS/MS revealed that ZSD contained 52 main chemical components. Compared with the model group, the cough symptoms of the rats in the different ZSD concentration groups were relieved, the EOS% index was lowered, and body weight was increased. HE staining showed that ZSD reduced airway inflammation, edema and hyperplasia, thereby improving the pathological structure of lung tissue, and the effect of high-dose ZSD was especially significant. Our most important finding was that ZSD blocked the entry of hypoxia-inducible factor-1α (HIF-1α), signal transducer and activator of transcription-3 (STAT3) and nuclear factor kappa-B (NF-κB) into the nucleus by interfering with PI3K/AKT1/mechanistic target of rapamycin (mTOR), and janus kinase 2 (JAK2) signaling factors. Consequently, inhibiting the release of cytokines and immunoglobulin-E, thereby reducing airway hyperresponsiveness (AHR) and partially reverses airway remodeling. ConclusionsThis study showed that ZSD can improve airway hyperresponsiveness and partially reverse airway remodeling by inhibiting the PI3K/AKT1/mTOR, JAK2/STAT3 and HIF-1α/NF-κB signaling pathways. Therefore, ZSD is an effective prescription for the treatment of CVA.

Predictive value of clinical features for anti-reflux therapy response in suspected gastroesophageal reflux-induced chronic cough.

Not all gastroesophageal reflux-induced cough (GERC) patients respond to anti-reflux treatment. It is not certain whether reflux-related symptoms or other clinical characteristics could indicate a successful response to anti-reflux treatment. In this study, we aimed to investigate the relationship between clinical features and anti-reflux response. We retrospectively analyzed the clinical characteristics of suspected GERC who had reflux-related symptoms or reflux evidence based on abnormal 24-hour esophageal pH value monitoring, or who had no evidence of other common causes of chronic cough in our chronic cough database with a standard case report form. All patients experienced anti-reflux treatment with proton pump inhibitors (PPIs) plus prokinetic agents for at least 2 weeks and were divided into responders and non-responders based on the treatment response. Among 241 patients with suspected GERC, 146 (60.6%) showed a successful response. There was no significant difference in regard to the proportion of reflux-related symptoms, and results of 24-hour esophageal pH value monitoring between responders and non-responders. Compared with non-responders, responders had higher proportions of nasal itching (21.2% vs. 8.4%; P=0.014), tickle in the throat (51.4% vs. 35.8%; P=0.025) and lower proportion of pharyngeal foreign body sensation (32.9% vs. 54.7%; P=0.001). Multivariate analysis showed that nasal itching [hazard ratio (HR): 1.593, 95% confidence interval (CI): 1.025-2.476, P=0.039], tickle in the throat (HR: 1.605, 95% CI: 1.152-2.238, P=0.005), pharyngeal foreign body sensation (HR: 0.499, 95% CI: 0.346-0.720, P<0.001) and sensitivity to at least one cough trigger (HR: 0.480, 95% CI: 0.237-0.973, P=0.042) were associated with the therapeutic response. Over half of suspected GERC patients benefited from anti-reflux therapy. A few clinical features rather than reflux-related symptoms might indicate a response to anti-reflux treatment. Further study is needed for the predictive value.

Pathogenesis and management of gastroesophageal reflux disease-associated cough: a narrative review.

Gastroesophageal reflux disease (GERD)-associated cough is defined as a special GERD with a predominant cough symptom and is a common cause of chronic cough. This review summarizes our current understanding on the pathogenesis and management of GERD-associated cough. Main literatures on the pathogenesis and management of GERD-associated cough were reviewed and our understandings derived from the published studies were showed then. Although esophageal-tracheobronchial reflex mainly underlies the pathogenesis of GERD-associated cough, its counterpart-tracheobronchial-esophageal reflex might exist and initiate the cough due to reflux induced by upper respiratory tract infection through the signaling of transient receptor potential vanilloid 1 linking airway and esophagus. The presence of reflux-associated symptoms such as regurgitation and heartburn along with coughing suggests an association between cough and GERD, which is supported by the objective evidence of abnormal reflux as detected by reflux monitoring. Although there is no general consensus, esophageal reflux monitoring provides the main diagnostic criteria for GERD-associated cough. Despite that acid exposure time and symptom associated probability are useful and mostly employed reflux diagnostic criteria, they are imperfect and far from being the gold standard. Acid suppressive therapy has long been recommended as the first choice for GERD-associated cough. However, the overall benefits of proton pump inhibitors have been controversial and need to be further assessed, especially in patients with cough due to non-acid reflux. Neuromodulators have demonstrated potential therapeutic effects for refractory GERD-associated cough, for which anti-reflux surgery may also be a promising treatment option. Tracheobronchial-esophageal reflex might initiate reflux-induced cough provoked by the upper respiratory tract infection. It is necessary to optimize the current standards and to explore new criteria with higher diagnostic potency. Acid suppressive therapy is the first choice for GERD-associated cough, followed by neuromodulators and anti-reflux surgery for refractory GERD-associated cough.

Eosinophilic bronchitis: update and review

Eosinophilic bronchitis (EB) is a common cause of chronic cough, which shares similar airway eosinophilic inflammation with asthma, however, there is no airway hyperresponsiveness and airflow obstruction. The mechanism of the different phenotype between EB and asthma remains unclear. The differences in the location of airway inflammation, the level of inflammatory mediators, the imbalance of important metabolic pathways, and the degree of airway remodeling may result in different pathogenesis between EB and asthma. EB response well to inhaled corticosteroids but recurrence of EB is still high after treatment. The longer duration of treatment with inhaled corticosteroids could decrease the relapse rate. On the prognosis of EB, a long-term follow-up study suggested that EB should be a distinct entity rather than an early stage of asthma or chronic obstructive pulmonary disease.

Evaluation of Chronic Cough Etiologies in Children

Objective: Cough is one of the leading causes of hospitalization in children worldwide. It should be considered important because it can be a symptom of various serious diseases and affects the quality of life of the child. A differential diagnosis should be performed on all children with a chronic cough. This study aimed to determine the etiologies in patients evaluated for chronic cough. Material and Methods: The study included patients admitted to the pediatric immunology and allergy outpatient clinic, with the complaint of chronic cough between the ages of 0–18 years. Clinical and demographic characteristics of patients were recorded. Results: This study included 323 patients between the ages of 0-18years. The median age of the patients was 7 (interquartile range: 5-9.7) years. One hundred and forty five (45%) of the patients were female. One hundred seventy-nine (55.4%) patients had a family history of atopic diseases such as asthma and/or allergic rhinitis. The presence of aeroallergen sensitivity was demonstrated in 127 patients. One hundred and forty-four (44.6%) patients were diagnosed with asthma, 75 (23.2%) patients with wheezing, 54 (16.7%) patients with post-infectious cough, 43 (13.3%) patients with postnasal drip syndrome, 4 (1.2%) patients with gastroesophageal reflux, 2 (0.6%) patients with foreign body aspiration, and 1 (0.3%) patient with psychogenic cough. Moreover, two patients with asthma, and one patient with wheezing had reflux symptoms in addition to the diagnosis of asthma and wheezing. One patient was found to have a partial IgA deficiency, and 18 patients had hypogammaglobulinemia. Immunoglobulin replacement therapy was initiated for a patient with hypogammaglobulinemia. Of the 219 patients diagnosed with asthma or wheezing, 144 had an atopic disease in the family (p&amp;lt;0.001). It was found that one hundred and eighty-five patients (57.3%) had domestic smoke exposure. Furthermore, smoke exposure was observed in 58 (77.3%) of 75 patients under the age of 6 years who were followed up with the diagnosis of wheezing (p= 0.010). Conclusion: In our study, asthma, which is one of the most common causes of chronic cough in the literature, was found to be the most common cause. For a correct approach when making a differential diagnosis in pediatric patients presenting with chronic cough, the patient’s history, physical examination, laboratory tests, and risk factors should be evaluated as a whole with systematic evaluation.

Evaluation of Patients with Chronic Cough Referred to Pediatric Pulmonology Outpatient Clinic

Objective: A cough that lasts longer than four weeks in children is called chronic cough. The aim of this study is to determine the underlying causes of chronic cough. Material and Methods: Patients aged 0-18 years who were referred to Şanlıurfa Training and Research Hospital pediatric pulmonology outpatient clinic between 27 December 2021 and 30 June 2022 due to chronic cough were enrolled. Patients with known cystic fibrosis, primary ciliary dyskinesia, interstitial lung disease, asthma, bronchopulmonary dysplasia were excluded from the study. The “CHEST Guideline and Expert Panel Report” guideline was used in the approach to chronic cough. Results: 153 patients were included in this study. The most common causes of chronic cough were asthma (30.7%), protracted bacterial bronchitis (20.3%), and upper respiratory tract cough syndrome (11.1%). Wet cough was present in 60.8% of the patients with chronic cough and the most common diagnosis in patients with wet cough were protracted bacterial bronchitis (33.3%), pneumonia and other lung infections (17.2%) and bronchiectasis (12.9%). The most common diagnoses were asthma (68.3%), upper airway cough syndrome (6.7%), and natural recovery (6.7%) in patients with dry cough. Failure to thrive was more common in patients with wet cough than patients with dry cough (p&amp;lt;0.030) and fever, weight loss and desaturation were only present in patients with wet cough. Conclusion: The most common reasons are asthma, protracted bacterial bronchitis and upper airway cough syndrome. The differential diagnosis should be made by pediatricians based on specific cough pointers, careful physical examination and tests performed in line with the recommendations of the guidelines.

Dijagnostika i terapija hroničnog kašlja

A cough that lasts for more than 8 weeks in adults (those older than 15 years) and more than 4 weeks in children is considered chronic and poses a significant health problem, as it can lead to feelings of fatigue, sleep disturbances, hoarseness, disruption of daily activities, vomiting, and often in women, even incontinence. The differential diagnosis of chronic cough in adults and children has its specificities. In certain cases, the etiological factor remains unknown when referring to unexplained (idiopathic) chronic cough. This paper presents the results of a systematic review of publications in medical databases (PubMed) and guidelines from the European Respiratory Society (ERS) and the American College of Chest Physicians (CHEST), related to the diagnosis and treatment of chronic cough. Diagnostic investigations should be focused on the most common causes of chronic cough. In adults, these include asthma, chronic obstructive pulmonary disease, bronchiectasis, interstitial lung disease, lung malignancy, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux disease, and upper airway cough syndrome. In children, the most common causes of chronic cough are asthma, protracted bacterial bronchitis, cystic fibrosis, primary ciliary dyskinesia, bronchiectasis, tracheobronchomalacia, pertussis, habitual (psychogenic) cough, and foreign body aspiration. The treatment primarily involves excluding medications that might have chronic cough as an adverse effect. Therapy is directed toward treating the underlying cause of chronic cough. If the cough persists despite treatment (refractory cough) or if it's idiopathic, neuromodulatory medications are employed (opioids, gamma-aminobutyric acid analogs, tricyclic antidepressants). Therapeutic options also include breathing and vocal techniques, superior laryngeal nerve blocks, and vocal cord medialization injections. Drugs directly inhibiting sensory receptors (P2X3, TRPV-1, and NK-1 inhibitors) are currently under clinical trial investigation. The use of validated tests is crucial for assessing therapeutic effectiveness. The etiological factors of chronic cough can have both infectious and non-infectious origins and are not always related to lung diseases. Considering that chronic cough is regarded as a condition of hypersensitivity, when causal treatment does not yield satisfactory results or when dealing with idiopathic chronic cough, therapy is directed towards central or peripheral neuromodulation, as well as techniques involving breathing and vocal production.

AN UNUSUAL CASE OF CHRONIC COUGH IN A PEDIATRIC PATIENT

<h3>Introduction</h3> Common causes of chronic cough in children are postinfectious, asthma, rhinosinusitis, and gastroesophageal reflux. Sensory neuropathic cough (SNC) is a rare cause of chronic cough in children. Its diagnosis is by exclusion; therefore, treatment is often delayed. We present a difficult pediatric case of sensory neuropathic cough. <h3>Case Description</h3> A 12-year-old female with well-controlled asthma developed a new-onset dry to wet cough after a viral infection that persisted for 6 weeks. Symptoms occurred both day and night. No wheezing was reported. She was hoarse but was able to speak in full sentences between coughing. There were no apparent triggers. Initial treatment with daily inhaled corticosteroid, long and short-acting beta-2-agonists, oral leukotriene receptor antagonist, and short courses of systemic steroids failed to relieve her symptoms. The addition of oral histamine-1-and-2-receptor antagonists, intranasal topical steroids and antihistamines, and antibiotics for potential sinus infection was also unsuccessful. Impulse oscillometer and computed tomography of the chest showed no abnormalities. Laryngoscopy was negative for vocal cord dysfunction, pooling of secretions, masses, polyps, or laryngeal swelling. She was seen by a neurologist 8 weeks after the cough began where she was diagnosed with sensory neuropathic cough and started on amitriptyline, resolving her cough. <h3>Discussion</h3> Our case illustrates the challenges of diagnosing sensory neuropathic cough as there are no standardized diagnostic criteria. Peripheral and central neurological sensitization are potential pathophysiologic explanations. Neuromodulating agents such as amitriptyline and gabapentin can potentially provide relief to some. Our patient had resolution of symptoms after use of amitriptyline.

Changes of the airway reactivity in patients with rhinosinusitis

Abstract Rhinosinusitis is one of the most common conditions in primary and secondary care all over the world. Rhinosinusitis together with asthma and gastroesophageal reflux disease represent the most common causes of chronic cough. The relationship between rhinosinusitis and cough is still not completely understood, however, direct stimulation of nasal mucosa, upper airway cough syndrome, inflammation of the airways, and cough reflex sensitisation play the crucial role in the pathogenesis of chronic cough.

Usefulness of simultaneous impulse oscillometry and spirometry with airway response to bronchodilator in the diagnosis of asthmatic cough

Objective: Some of the most common causes of chronic cough include cough variant asthma (CVA), bronchial asthma (BA), and asthma–COPD overlap (ACO). Although there is some overlap in the etiology of these diseases, it is clinically important to attempt an early differential diagnosis due to treatment strategies and prognoses. Methods: Spirometry and impulse oscillometry (IOS) before and after bronchodilator inhalation were analyzed for clinically diagnosed CVA (cCVA, n = 203), BA (cBA, n = 222), and ACO (cACO, n = 61). Results: A significant difference in ΔFEV1 was observed between cBA and cCVA (ΔFEV1 improvement of 122.5 mL/5.4% and 65.7 mL/2.2%, respectively), but no difference was observed in ΔPEF, ΔV50, or ΔV25. Except for R20 (resistance at 20 Hz), significant differences between the three groups were observed in IOS. In IOS, cCVA and cBA showed comparable peripheral airway response to bronchodilator which was thought to be commensurate with changes in V50 and V25. cACO improved ΔFEV1 improvement of 81.0 mL/6.2% and was distinguished by a downward respiratory system reactance (Xrs) waveform with a limited bronchodilator response. FEV1/FVC, %FEV1, and %V25 had relatively strong correlations with the three IOS parameters, X5 (reactance at 5 Hz), resonant frequency (Fres), and low-frequency reactance area (ALX), in the correlation between IOS and spirometers. Conclusion: Changes in IOS parameters were more sensitive in this study than changes in FEV1 or the flow-volume curve. Considering the benefits and relevance of the two different tests, simultaneous IOS and spirometry testing were useful in the diagnosis of asthmatic cough.