Long-standing Cough Research Articles

Late-Onset Cerebellar Ataxia with Neuropathy: Uncovering the Role of RFC1 Gene Mutations

We report two unrelated patients with late-onset cerebellar ataxia associated with neuropathy and a long-standing dry cough. One patient had two siblings affected with sensory neuropathy and cough. Both probands had extensive investigations including genetics testing negative for most common ataxias as well as testing for paraneoplasic and other immunologic causes. Both patients showed an abnormal intronic expansion in the pentanucleotide AAGGG of the gene RFC1. This etiology is being reported as frequent cause of adult-onset ataxia; the presence of cough may lead to the correct diagnosis.

Occupational cold exposure in relation to incident airway symptoms in northern Sweden: a prospective population-based study

ObjectiveTo determine if occupational exposure to cold environments is associated with incident airway symptoms in previously healthy workers.MethodsA prospective, survey-based, closed-cohort study was conducted on a sample of 5017 men and women between 18 and 70 years of age, living in northern Sweden. Data on occupation, occupational and leisure-time cold exposure, airway symptoms, general health, and tobacco habits were collected during the winters of 2015 (baseline) and 2021 (follow-up). Stepwise multiple logistic regression was used to determine associations between baseline variables and incident airway symptoms.ResultsFor individuals working at baseline, without physician-diagnosed asthma or chronic obstructive pulmonary disease, reporting any occupational cold exposure was associated with incident wheeze (OR 1.41; 95% CI 1.06–1.87) and incident productive cough (OR 1.37; 95% CI 1.06–1.77), but not incident long-standing cough (OR 0.98; 95% CI 0.74–1.29), after adjusting for age, body mass index, daily smoking, and occupational physical workload. Detailed analysis of the occupational cold exposure rating did not reveal clear exposure–response patterns for any of the outcomes.ConclusionsOccupational cold exposure was robustly associated with incident wheeze and productive cough in previously healthy workers. This adds further support to the notion that cold air is harmful for the airways, and that a structured risk assessment regarding occupational cold exposure could be considered for inclusion in the Swedish workplace legislation. Further studies are needed to elaborate on exposure–response functions, as well as suggest thresholds for hazardous cold exposure.

Lady Windermere Syndrome: An Interesting Clinical and Radiological Presentation

Lady Windermere Syndrome is an uncommon pulmonary disease characteristically observed in elderly white females with chronic cough suppression and dyspnea. It is classically associated with Mycobacterium avium complex (MAC) species. An 84-year-old female was evaluated for longstanding non-productive cough and intermittent dyspnea. A chest computed tomography scan revealed densities in the right upper lobe and scattered nodular-cystic bronchiectasis. Biopsy was negative for malignancy; however, bronchioalveolar lavage studies showed presence of MAC. Patient was treated with a 12-month course of azithromycin, rifampin and ethambutol resulting in resolution of her symptoms.

INTRACTABLE COUGH CAUSING SPONTANEOUS RECTUS SHEATH HEMATOMA

TOPIC: Signs and Symptoms of Chest Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cough is a physiologic mechanism that causes airways to be cleared of foreign materials and excess secretions. The violent expiration is associated with rapid contraction of the diaphragm and the abdominal wall muscles leading to an increase in intraabdominal pressures. Longstanding untreated cough can lead to spontaneous abdominal wall hematomas. (1) CASE PRESENTATION: A 65-year-old gentleman presented to the Emergency Room with right lower quadrant abdominal pain of one-week duration. He had no past medical history. He was noted to have a persistent intractable cough for one month. Prior to the onset of cough, he had one week of loss of taste and smell, nasal congestion, nasal discharge and postnasal drip. According to him, the cough was so bad that he felt like he was going to burst. Although his family insisted, he did not get the cough evaluated. His vital signs were stable. Physical examination showed ecchymosis, a small palpable mass and tenderness in the right lower quadrant. Lung exam was unremarkable. Lab work unremarkable with normal platelet count and coagulation profile. Computed Tomography (CT) of the abdomen/pelvis showed an intramuscular vascular mass of 9 cm within the right rectus abdominis suggestive of a hematoma which was managed conservatively. Of note, he was not on any anticoagulants. On 1 month follow-up, he had complete resolution of abdominal pain, ecchymosis, mass and tenderness in the right lower quadrant. However, he continued to have a persistent cough for which he was referred to pulmonology. He visited the pulmonary clinic after 5 months of referral. At that time, he had become dependent on over-the-counter (OTC) oral decongestants and antihistamines. He had no reflux symptoms, no allergies, was a lifetime nonsmoker, employed as a banker and had a Labrador for 11 years. CT chest showed normal lung parenchyma. Pulmonary function tests revealed features of mild obstructive lung disease. His OTC medications were stopped and he was given a course of oral prednisone along with fluticasone and azelastine nasal spray with dramatic improvement and complete resolution of cough. DISCUSSION: Sustained cough results in over contraction and overstretching of abdominal muscles with an increase in intra-abdominal pressures. (2) Vigorous coughing plausibly generates shear forces high enough to tear superior and inferior epigastric vessels along the posterior aspect of long rectus muscle which results in rectus sheath hematomas. Almost 29% of spontaneous rectus sheath hematomas are the result of sustained cough the risk of which increases with the use of anticoagulants. (3) While these hematomas are conservatively managed, patients should undergo a thorough evaluation and treatment of cough to prevent its recurrence. CONCLUSIONS: This case highlights the potential of sustained vigorous cough to cause abdominal wall hematomas even in the absence of anticoagulants. REFERENCE #1: 1. Fuller RW, Jackson DM. Physiology and treatment of cough. Thorax. 1990;45(6):425-430. doi:10.1136/thx.45.6.425 REFERENCE #2: 2. Kodama K, Takase Y, Yamamoto H, Noda T. Cough-induced internal oblique hematoma. J Emerg Trauma Shock. 2013;6(2):132-134. doi:10.4103/0974-2700.110789 REFERENCE #3: 3. Cherry WB, Mueller PS. Rectus sheath hematoma: review of 126 cases at a single institution. Medicine (Baltimore). 2006;85(2):105-110. doi:10.1097/01.md.0000216818.13067.5a DISCLOSURES: No relevant relationships by Fady Jamous, source=Web Response No relevant relationships by Swaminathan Perinkulam Sathyanarayanan, source=Web Response

Among respiratory symptoms, wheeze associates most strongly with impaired lung function in adults with asthma: a long-term prospective cohort study

BackgroundAsthma is a common disease and a major public health concern. Respiratory symptoms are related to its prognosis, which in turn associates with lung function. Still this association on a...

A-41 years old male with alcoholic cardiomyopathy at Tabanan General Hospital, Bali-Indonesia: a case report

Background: Alcoholic cardiomyopathy is a form of toxic cardiomyopathy which develops as a result of long-standing chronic ingestion of alcohol. Its clinical findings share similar features to other forms of dilated cardiomyopathy. Diagnosis can be made based on the history of long term alcohol abuse, clinical findings, and supporting diagnostic studies. This case report aims to overview alcoholic cardiomyopathy; from establishing the initial diagnosis to the treatment given for the condition.Case Description: A 41 years old male came to the emergency department unit with shortness of breath since last few days. Shortness of breath was said to be getting worse over time and progressed to breathlessness at rest. Other complaints were palpitations, fatigue, and long-standing cough. The patient was found to have a history of drinking alcohol in large quantities since 27 years ago. The blood pressure was 110/70 mm Hg, pulse rate 105 beats/min, and respiratory rate was 20 breaths/min. Slight edemas on both legs were also found. From auscultation examination, bibasilar crepitation on both lungs was found. Cardiac examination showed systolic murmur of mitral regurgitation (MR) and tricuspid regurgitation (TR). On supporting investigation, a chest x-ray showed cardiomegaly (cardiothoracic ratio; 57%). ECG examination showed sinus tachycardia and left atrial (LA) and left ventricular (LV) enlargement. Trans-thoracal echocardiographic (TTE) examination revealed; RWMA: global hypokinetic-akinetic, multi-chamber dilated and severe LV systolic dysfunction (EF 29%) and diastolic function (Grade IV (E/A Ratio>4)). Valve examination showed moderate-severe MR and moderate TR (TVG 40 mmHg).Conclusion: Alcohol cardiomyopathy is one of the most common causes of heart failure in young age and carries a poor prognosis if not treated properly. Treatment of alcoholic cardiomyopathy mainly includes total alcohol abstinence along with drugs used to treat systolic heart failure to reverse the condition and correct any nutritional deficiencies.

Unusual Coexistence of Pulmonary Tuberculosis and Hydatid Disease

ABSTRACT Tuberculosis and hydatidosis are both infectious diseases commonly involving the pulmonary system and exhibiting a wide spectrum of clinical manifestations of varying severity. The simultaneous occurrence of pulmonary tuberculosis and hydatid disease is extremely rare, reported sporadically in the literature. We herein report two cases where this rare coexistence was proven after radiological features aroused suspicion. The first patient was a young female with a short history of fever and cough. She had miliary mottling and a cystic lesion on imaging. Second patient was an elderly lady with a long-standing cough, dyspnea, and hemoptysis. She had multiple cystic and cavitatory lesions on imaging. Both of them were managed with medical therapy successfully. The possibility of hydatid tuberculosis coinfection should be kept in mind in endemic areas in the relevant clinical scenarios. How to cite this article Laldayal D, Utpat K, Joshi JM. Unusual Coexistence of Pulmonary Tuberculosis and Hydatid Disease. J Postgrad Med Edu Res 2018;52(1):36-39.

Keratoderma as a Paraneoplastic Sign on NSCLC Patient - Case Report

Palmoplantar keratoderma is a dermatosis that presents as hyperkeratosis of the palms and soles. Skin disorders of the feet can affect the glabrous skin on the dorsal aspects, or the thick skin on the plantar aspectsthereof, or both. Some can affect one foot, and others both. These diseases can be inflammatory, genetically inherited, infectious orneoplastic in origin. It is important to identify them and to start treatment early. If not treated, some may lead to severe pain on walking, inability to wear shoes, or even amputation with serious disability. We present a patient with severe treatment-resistant keratoderma of the feet, in addition to a long-standing dry cough. Because of the cough, a CT scan of the chest was done and a 2.5×2.5 cm nodule was detected in the left lower lobe of the lung. A biopsy confirmed the diagnosis of non-small cell lung cancer (NSCLC) stage IA. It was resected entirely with left lower lobectomy. The keratoderma resolved spontaneously within a few weeks of surgery.

Mycoplasma pneumoniae, Chlamydophila pneumoniae, Pneumocystis jirovecii and herpes infection in children with recurrent respiratory diseases

Rationale: Acute respiratory disorders (ARD) have the highest proportion among infectious disease in children. Despite the fact that serological diagnostics of Mycoplasma pneumoniae, Chlamydophila pneumoniae, Pneumocystis jirovecii, herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus type 6 (HHV-6) has been available for many years, up to now some objective limitations exist that hinder reliable differentiation between the viral carriage, past or current infection. There are no widely accepted guidelines that would suggest unified strategies for diagnosis and what is of utmost importance, for therapeutic intervention on a case-to-case basis. The rationale for this study was based on underestimation of the burden of these infections in children with prolonged periods of cough and recurrent ARDs, as well as the necessity to further develop diagnostic and management strategies. Aim: To determine causative role of M. pneumoniae, P. jirovecii, C. pneumoniae, HSV-1, -2, EBV, CMV, HHV-6 in children with recurrent ARDs hospitalized to an in-patient unit. Materials and methods: We examined 50 children with recurrent ARDs aged from 1 to 7 years who were hospitalized with an acute respiratory infection. Laboratory assessments included determination of the markers of infections caused by M. pneumoniae, P. jirovecii, C. pneumoniae, HSV- 1, -2, EBV, CMV, HHV-6 by means of polymerase chain reaction, immunoenzyme analysis, and indirect immunofluorescence reaction. Results: Markers of mycoplasma, chlamydial, pneumocystic infection, as well as HSV-1, -2, EBV, CMV, HHV-6 were found in 84% (42 / 50) cases. Active infection (acute or active persistent) was found in 38% (19 / 50) patients. The most prevalent was pneumocystic infection diagnosed in 12 (24%) patients; one fifth of all patients had mycoplasma (in 10 (20%) of cases), whereas herpetic and chlamydial infections were less frequent (4 (8%) and 1 (2%) of cases, respectively). Twelve (24%) patients had a single infection, while the others had mixed infections. Conclusion: We were able to confirm the possibility of combined M. pneumonia / P. jirovecii infection (8%) in children with recurrent ARDs and history of longstanding cough; this is important for an assessment of efficacy of causative treatment. Measurement of serum titers of specific immunoglobulins M and G along with DNA/antigens of potential causative organisms can be sufficient to choose specific antibacterial treatment of obstructive bronchitis and pneumonia in children with the history of longstanding cough and recurrent bronchial obstruction.

Young patient with generalized lymphangiomatosis: Differentiating the differential.

We present the case of a 19-year-old man who was extensively evaluated in multiple centres for long-standing cough, dyspnea, and hemoptysis without a definitive diagnosis. His chest radiograph at presentation showed mediastinal widening, bilateral pleural effusions, and Kerley B lines. Computed tomography of the thorax showed a confluent, fluid-density mediastinal lesion enveloping the mediastinal viscera without any mass effect. There were bilateral pleural effusions, prominent peribronchovascular interstitial thickening, interlobular septal thickening and lobular areas of ground glass density with relative sparing of apices. There were a few dilated retroperitoneal lymphatics and well-defined lytic lesions in the bones. In this case report, we aim to systematically discuss the relevant differentials and arrive at a diagnosis. We also briefly discuss the treatment options and prognosis along with our patient's course in the hospital and final outcome.

The Clinical Course of Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia

Current understanding of the clinical course of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is poor and based predominantly on small case series. In our clinical experience, we have found that the diagnosis of DIPNECH is frequently delayed because respiratory symptoms are ascribed to other lung conditions. The objectives of this study were to collect and analyze longitudinal clinical data on pulmonary physiology, chest high-resolution CT (HRCT) imaging, and therapies to better delineate the course of disease. We established a cohort of patients (N = 30) with DIPNECH seen at our institution. We used descriptive statistics to summarize cohort characteristics and longitudinal analytic techniques to model FEV1 % predicted (FEV1%) over time. All subjects were women who presented with long-standing cough and dyspnea. The majority had an FEV1% < 50% at the time of diagnosis. Forty percent were given a diagnosis of asthma as the cause for physiologic obstruction. The mean FEV1% for the entire cohort showed no statistically significant decline over time, but 26% of the subjects experienced a 10% decline in FEV1 within 2 years. Among the pathology samples available for review, 28% (five of 18) had typical carcinoids and 44% had associated constrictive bronchiolitis. We propose clinical diagnostic criteria for DIPNECH that incorporate demographic, pulmonary physiology, HRCT imaging, and transbronchial and surgical lung biopsy data. DIPNECH is a female-predominant lung disease manifested by dyspnea and cough, physiologic obstruction, and nodules on HRCT imaging. Additional research is needed to understand the natural history of this disease and validate the proposed diagnostic criteria.

Subjects with COPD and productive cough have an increased risk for exacerbations and death

Chronic bronchitis is related to worse general health status, exacerbations and mortality among subjects with COPD. Also less longstanding cough and phlegm may be related to worse prognosis in COPD but this has rarely been evaluated in population-based studies. To evaluate the relationship between productive cough, exacerbations and mortality among subjects with and without COPD. All subjects with COPD (n = 993) were identified together with sex- and age matched reference subjects without obstructive lung function impairment from four population-based cohorts in 2002-04. Baseline spirometry and structured interview including data on exacerbations last 12 months were used in this study (n = 1986) together with mortality data collected until February 2012. Productive cough was more common in COPD than non-COPD (42.8 vs. 23.5%, p < 0.001), more common in men than women, but associated to exacerbations in both sexes. COPD-subjects with productive cough had the highest risk for exacerbations in both sexes and they had a significantly increased risk for death (HR 1.48, 95% CI 1.13-1.94) also when adjusted for sex, age, BMI, smoking habits and heart disease. Productive cough was common and increased the risk for exacerbations in both sexes, in both COPD and non-COPD. COPD-subjects with productive cough had the highest risk for exacerbations and a significantly higher risk for death also after adjustment for common risk factors.

Frequent cough in unsatisfactory controlled asthma--results from the population-based West Sweden Asthma study.

BackgroundAsthma is a complex disease presenting with variable symptoms which are sometimes hard to control. The purpose of the study was to describe the prevalence of asthma symptoms, use of asthma medications and allergic sensitization in subjects with asthma. We also related those indices to the level of asthma control, lung function and in particular, cough.MethodsAn extensive questionnaire was sent to randomly selected adults from the West Sweden region. Clinical examinations and interview were performed in a subset. Of the participants, 744 were defined as having an ongoing asthma - reported ever having asthma or physician diagnosed asthma and one of the following – use of asthma medications, recurrent wheeze or attacks of shortness of breath with or without wheeze in the last 12 months. A respiratory disease-free control group of 847 subjects was also described.ResultsAccording to GINA guidelines, 40.6% of the asthmatics had partly controlled and 17.8% had uncontrolled asthma. Asthmatic subjects reported significantly more symptoms in the last 12 months than the control group – wheezing (79.4 vs 9.2%), shortness of breath (36.1 vs 2.5%), wheezing with shortness of breath (58.7 vs 1.3%). Important complaints were morning cough (42.5 vs 15.5%), cough with sputum production (36.1 vs 6.8%) and longstanding cough (32.5 vs 11.1%), which bothered two thirds of the uncontrolled and one third of partly controlled subjects. Asthma medications were used by 87.5% of the asthmatics, although around 30% of them who had insufficiently controlled disease used only short-acting beta-agonists. Asthmatics also had lower lung function, reacted to lower doses of methacholine that the controls and 13.6% of them had a FEV1/FVC ratio below 0.7. Allergic rhinitis was reported by 73.8% of the asthmatics and they were more frequently sensitized to several common allergens.ConclusionsApproximately 60% of asthmatics from this population-based study had insufficiently controlled asthma and persistent complaints, despite a high use of asthma medications. These self-reported symptoms were supported by clinical examination data. Increased cough frequency is an indicator of a more severe and difficult to control disease and should be considered when asthma is characterized.

Prevalence trends in respiratory symptoms and asthma in relation to smoking - two cross-sectional studies ten years apart among adults in northern Sweden

Background Smoking is considered to be the single most important preventable risk factor for respiratory symptoms. Estimating prevalence of respiratory symptoms is important since they most often precede a diagnosis of an obstructive airway disease, which places a major burden on the society. The aim of this study was to estimate prevalence trends of respiratory symptoms and asthma among Swedish adults, in relation to smoking habits. A further aim was to estimate the proportion of respiratory symptom and asthma prevalence attributable to smoking.Methods Data from two large-scale cross-sectional surveys among adults performed in northern Sweden in 1996 and 2006 were analysed. Identical methods and the same questionnaire were used in both surveys. The association between smoking, respiratory symptoms and asthma was analysed with multiple logistic regression analyses. Changes in prevalence of respiratory symptoms and asthma from 1996 to 2006 were expressed as odds ratios. Additionally, the population attributable risks of smoking were estimated.Results The prevalence of most respiratory symptoms decreased significantly from 1996 to 2006. Longstanding cough decreased from 12.4 to 10.1%, sputum production from 19.0 to 15.0%, chronic productive cough from 7.3 to 6.2%, and recurrent wheeze from 13.4 to 12.0%. Any wheeze and asthmatic wheeze remained unchanged. This parallels to a decrease in smoking from 27.4 to 19.1%. In contrast, physician-diagnosed asthma increased from 9.4 to 11.6%. The patterns were similar after correction for confounders. All respiratory symptoms were highly associated with smoking, and the proportion of respiratory symptoms in the population attributed to smoking (PAR) ranged from 9.8 to 25.5%. In 2006, PAR of smoking was highest for recurrent wheeze (20.6%).Conclusions In conclusion, we found that respiratory symptoms, in particular symptoms common in bronchitis, decreased among adults in northern Sweden, parallel to a decrease in smoking from 1996 to 2006. In contrast, the prevalence of physician-diagnosed asthma increased during the same time-period. Up to one fourth of the respiratory symptom prevalence in the population was attributable to smoking.

Alarmingly high prevalence of smoking and symptoms of bronchitis in young women in Sweden: a population-based questionnaire study.

Background:After 10 years of a decrease in smoking among young people in Sweden, we now have indications of increased smoking.Aims:To provide up-to-date information on the prevalence of smoking and smoke-associated respiratory symptoms in young adults in Sweden, with a special focus on possible gender differences.Methods:In the West Sweden Asthma Study, a detailed postal questionnaire focusing on asthma, respiratory symptoms, and possible risk factors was mailed to 30,000 randomly selected subjects aged 16–75 years. The analyses are based on responses from 2,702 subjects aged 16–25 years.Results:More young women than men were smokers (23.5% vs. 15.9%; p<0.001). Women started smoking earlier and smoked more. Symptoms such as longstanding cough, sputum production, and wheeze were significantly more common in smokers. In the multiple logistic regression analysis, smoking significantly increased the risk of recurrent wheeze (odds ratio (OR) 2.0 (95% CI 1.4 to 3.0)) and sputum production, (OR 2.4 (95% CI 1.9 to 3.1)).Conclusions:The alarmingly high prevalence of smoking among young women was parallel to a similarly high prevalence of bronchitis symptoms. This is worrisome, both in itself and because maternal smoking is a risk factor for illness in the child. Adverse respiratory effects of smoking occur within only a few years of smoking initiation.

Photo Quiz: Female with Long-Standing Cough

A 32-year-old female of Thai origin reported to the pulmonology outpatient department with a history of productive cough, sporadic hemoptysis, malaise, and nighttime fever and a 12-week duration of weight loss. She was a lifetime nonsmoker. Physical examination revealed no significant abnormalities, and normal breath sounds were noted during auscultation. Blood analysis showed a hemoglobin concentration of 7.1 mmol/liter, a white blood cell count of 15.1 × 109 cells/liter, and a C-reactive protein concentration of 29 mg/liter. The patient was seronegative for HIV. A sputum sample was submitted to the microbiology laboratory for microscopy and bacterial and mycobacterial cultures. The Gram stain revealed a large number of leukocytes but no bacteria; several slender linear unstained structures were observed (Fig. 1). Fig 1 Gram stain of expectorated sputum sample. Arrows mark two of the slender, linear unstained structures. (For answer and discussion, see page 1353 in this issue [doi:10.1128/JCM.01201-12].)

A 54 year-old man with a chronic cough — Chronic cough: don't forget drug-induced causes

A 54 year-old man consults about a long-standing cough: his wife encouraged him to attend as she was tired of hearing him cough all the time. He is a bit vague about when it started, but it must be ‘nearly a year’. He has consulted his usual general practitioner about the cough three times. Eight months ago he presented with a ‘chesty’ cough associated with a feverish illness and an upper respiratory tract infection; he was prescribed a course of antibiotics which he thinks might have slightly improved the cough, though it did not fully resolve. Two subsequent consultations resulted in a further course of antibiotics and a trial of a salbutamol inhaler, neither of which appear to have made any difference. The clinical notes record that his chest was ‘clear’ at each of these consultations. He describes himself as ‘generally well’, though he has been tired recently which he attributes to the long hours he is working. He smoked for about 15 years but quit in his mid-thirties.

A 54 year-old man with a chronic cough — A primary care perspective from Canada

A 54 year-old man consults about a long-standing cough: his wife encouraged him to attend as she was tired of hearing him cough all the time. He is a bit vague about when it started, but it must be ‘nearly a year’. He has consulted his usual general practitioner about the cough three times. Eight months ago he presented with a ‘chesty’ cough associated with a feverish illness and an upper respiratory tract infection; he was prescribed a course of antibiotics which he thinks might have slightly improved the cough, though it did not fully resolve. Two subsequent consultations resulted in a further course of antibiotics and a trial of a salbutamol inhaler, neither of which appear to have made any difference. The clinical notes record that his chest was ‘clear’ at each of these consultations. He describes himself as ‘generally well’, though he has been tired recently which he attributes to the long hours he is working. He smoked for about 15 years but quit in his mid-thirties.

A 54 year-old man with a chronic cough — A primary care perspective from Argentina

A 54 year-old man consults about a long-standing cough: his wife encouraged him to attend as she was tired of hearing him cough all the time. He is a bit vague about when it started, but it must be ‘nearly a year’. He has consulted his usual general practitioner about the cough three times. Eight months ago he presented with a ‘chesty’ cough associated with a feverish illness and an upper respiratory tract infection; he was prescribed a course of antibiotics which he thinks might have slightly improved the cough, though it did not fully resolve. Two subsequent consultations resulted in a further course of antibiotics and a trial of a salbutamol inhaler, neither of which appear to have made any difference. The clinical notes record that his chest was ‘clear’ at each of these consultations. He describes himself as ‘generally well’, though he has been tired recently which he attributes to the long hours he is working. He smoked for about 15 years but quit in his mid-thirties.

Long‐term respiratory symptoms following oesophageal atresia

BackgroundOesophageal atresia (OA) is a congenital malformation that can lead to persistent respiratory symptoms in adulthood.AimTo describe the prevalence of respiratory symptoms in adulthood in a population-based study of patients with repaired OA and to compare this with the prevalence in the general population.MethodsOf 80 patients operated for OA in Gothenburg in 1968–1983, 79 were located. The patients received a questionnaire on respiratory symptoms. Controls were 4979 gender- and age-matched subjects who answered the same questions.ResultsThe questionnaire was answered by 73 of 79 (92%) patients. Physician-diagnosed asthma was reported by 30% in the OA group vs 10% in the control group (OR 4.1; 95% CI 2.4–6.8), and recurrent wheeze in 29% vs 5.5% (OR 6.9; 4.1–11.6). Also wheeze during the last year, asthma medication, a long-standing cough, cough with sputum production and chronic bronchitis were significantly more common among the patients with OA. In contrast, there was no significant difference regarding risk factors for asthma. The prevalence of respiratory symptoms did not appear to decrease with age.ConclusionA high prevalence of respiratory symptoms remains among adult patients with repaired OA. Many of the patients had an asthma diagnosis. However, asthma heredity or allergic rhinitis was not overrepresented.