Non-specific Cough Research Articles

Approach to chronic cough.

Chronic cough does affect quality of life in children. Most of the times it is treated with over-the-counter cough syrups and antibiotics. The etiology of chronic cough is so diverse, that treatment needs to be directed to the specific etiology, rather than treating symptomatically. Grossly, chronic cough is classified as specific and non-specific cough. Allergic conditions, followed by tuberculosis are more commonly encountered etiologies in India. Baseline investigations to be performed are chest radiograph and peak flow metry. If specific cause of cough is not obvious, then therapeutic trial with β2 agonist, followed by peak flowmetry to evaluate reversibility of airway hypersensitivity, is useful to label the child asthmatic or non-asthmatic. Rampant uses of antibiotics need to be avoided for conditions like asthma. If tuberculosis is diagnosed or suspected, it is better to treat the child, rather than giving therapeutic trial. Over-the-counter cough syrups are as good as placebo, and should be avoided. Trial of anti asthma, anti allergic rhinitis and anti reflux therapies are avoided, unless the diagnosis is one of these conditions. If the child is distressed or the case seems to be complicated, it is best to refer the child to a tertiary care centre and keep a close follow up.

Tos en el niño

Cough during childhood is very common, and is one of the most frequent reasons for consultation in daily pediatric practice. The causes differ from those in adults, and specific pediatric guidelines should be followed for correct diagnosis and treatment. The most common cause of cough in children is viral infection producing “normal cough”, but all children with persistent cough, i.e. a cough lasting more than 4-8weeks or “chronic cough”, must be carefully evaluated in other to rule out specific causes that may include the entire pediatric pulmonology spectrum. The treatment of cough should be based on the etiology. Around 80% of cases can be diagnosed using an optimal approach, and treatment will be effective in 90% of them. In some cases of “nonspecific chronic cough”, in which no underlying condition can be found, empirical treatment based on the cough characteristics may be useful. There is no scientific evidence to justify the use of over-the-counter cough remedies (anti-tussives, mucolytics and/or antihistamines), as they could have potentially serious side effects, and thus should not be prescribed in children.

Interstitial lung disease: Diagnostic approach

Interstitial lung disease (ILD) is a final common pathway of a broad heterogeneous group of parenchymal lung disorders. It is characterized by progressive fibrosis of the lung leading to restriction and diminished oxygen transfer. Clinically, the presenting symptoms of ILD are non-specific (cough and progressive dyspnea on exertion) and are often attributed to other diseases, thus delaying diagnosis and timely therapy. Clues from the medical history along with the clinical context and radiologic findings provide the initial basis for prioritizing diagnostic possibilities for a patient with ILD. An accurate prognosis and optimal treatment strategy for patients with ILDs can only be after an accurate diagnosis. This review will assist pulmonary physicians and medicine specialist in recognition of ILD. Extensive literature search has been made through PubMed and also Book References has been used for writing this review.

Voice Treatment for Nonspecific Chronic Cough and Paradoxical Vocal Fold Motion Disorder in Children

Seminars in Speech and Language, Volume 34, No. 1, is devoted to types and treatment of voice disorders in children. School speechlanguage pathologists (SLPs) may sometimes find it difficult to put children with voice problems on their caseloads because they must show how the disorder affects academic performance. The authors in this issue of Seminars make clear that pediatric voice disorders do impact academic performance. Voice disorders are associated with school absenteeism; decreased participation in academic classes, physical education, and extracurricular activities; and negative attention from classmates and school personnel, thus impacting academic performance and social well-being. Some voice disorders, such as vocal nodules, are familiar to SLPs; others, such as paradoxical vocal fold motion disorder (PVFMD) and nonspecific chronic cough (NSCC), are less familiar. In their article in this issue, Gallena and Kerins describe the nature, assessment, and treatment of NSCC and PVFMD.

Urine Leukotriene E4 Levels in Children with Nonspecific Isolated Chronic Dry Cough.

Chronic cough is the most common complaint during childhood. Various pathophysiologic mechanisms may cause cough. Knowledge of the mechanisms underlying chronic cough plays an important role in the choice of treatment to evaluate the role of leukotrienes in children with nonspecific isolated chronic dry cough. The patient group consisted of children with isolated chronic dry cough persisting for >4 weeks and the control group included healthy children. Medical histories were elicited and physical examinations were performed, then respiratory function testing was done and chest X-rays were obtained. Patients were given inhaled corticosteroid. The urine leukotriene E4 (uLTE4) levels in the patient and control groups was measured by enzyme immunoassay. The patient group included 55 patients, 25 of them were males between 6 and 12 years old. The control group included 25 healthy children between 6 and 12 years old, 12 of them were males. There were no pathologic findings on physical examinations, pulmonary function testing, and chest X-rays. The complaints of cough in 50 patients were resolved after treatment. The median level of uLTE4 was 73.1 ng/mmol creatinine (range, 15.59-787.55 ng/mmol creatinine) in the patient group, and 64.2 ng/mmol creatinine (range, 12-282 ng/mmol creatinine) in the control group. No significant difference was detected between the 2 groups with respect to age, gender, and uLTE4 levels. Different pathophysiologic mechanisms are known to influence nonspecific isolated chronic dry cough. Various mechanisms, other than leukotrienes, may also give rise to dry cough.

Diffuse alveolar hemorrhage as a manifestation of Behçet disease

Diffuse alveolar hemorrhage (DAH) is a rare life-threatening condition which refers to the presence of red blood cells within alveoli deriving from hemorrhage originating in the pulmonary microvasculature. It differs from alveolar filling, in which blood cells derive from localized bleeding, usually of bronchial origin. DAH may be part of diffuse alveolar injury of any origin. DAH should be considered a medical emergency due to the significant morbidity and mortality associated with respiratory failure, when secondary to impaired oxygen uptake from alveoli filled with erythrocytes. Patients with alveolar hemorrhage present with non-specific symptoms like dyspnea, cough and hemoptysis, which is not always present. They may develop acutely or insidiously over a few days. We present a case of a patient with probable Behçet's disease complicated by pulmonary capillaritis and DAH resulting in refractory respiratory failure and death.

Nonspecific Chronic Cough and Paradoxical Vocal Fold Motion Disorder in Pediatric Patients

Paradoxical vocal fold motion disorder and nonspecific chronic cough are laryngeal disorders that are newly identified within the speech-language pathologist's scope of practice. Recognizing the signs and symptoms of these disorders and providing practical and evidenced-based treatment is the focus of this article. Defining the role of the speech-language pathologist in treating these low incidence yet quickly remediated disorders provides the pediatric or school-based speech-language pathologist a unique service delivery challenge. A model that utilizes an interdisciplinary team to provide efficient and effective treatment outcomes is discussed.

Diagnóstico y tratamiento de la tos crónica en pediatría

Chronic cough is a symptom of various respiratory and non-respiratory conditions with negative impact on quality of life of children and their families. The pediatricians should focus their efforts in search for etiological diagnosis. A careful medical history and physical examination are the mainstays of diagnosis and guidance to further studies that may contribute to detection of final causes. The etiological identification of chronic cough must be followed by specific treatment. The symptomatic approach with antitussives and mucolytic drugs is exceptionally necessary and should be considered for some situations of nonspecific cough without any specific disease association.

Tonsillolith: a panoramic radiograph presentation.

Tonsilloliths are calcifications within a tonsillar crypt, involve primarily the palatine tonsil caused by dystrophic calcification as a result of chronic inflammation. Tonsilloliths are very uncommon and are microscopic. Tonsillar concretions sometimes produce symptoms which include non-specific chronic halitosis, irritable cough, dysphagia, otalgia and foreign body-like sensation or foul taste. Patients with tonsillolithiasis may also be asymptomatic, with their lesions being discovered incidentally on panoramic radiographs. This article presents an unusual case of multiple bilateral and asymptomatic tonsilloliths which were found during a routine panoramic radiographic examination.

Distribution of neuropeptides in nasal and nasopharyngeal mucosa in patients with the post nasal drip syndrome

OBJECTIVE The post nasal drip is a very common symptom of sinusitis, allergic rhinosinusopathy, the gastroesophageal reflux disease, but there are some patients, who have a post nasal drip, sensation of a foreign body in the nasopharynx and a non-specific irritant cough with no other symptoms or signs of sinus inflammations or allergy. In the posterior rhinoscopy mucus discharge is seen. Ethiology and pathogenesis of this syndrome evolution are still unclear. The aim of the study was to identify the neuropeptide appearance and distribution in nasal and nasopharyngeal mucosa in the patients with the isolated post nasal drip syndrome and the control group, for the comparison of the data. MATERIALS AND METHODS. We investigated the biopsies of nasal and nasopharyngeal mucosa from 11 adult patients, who had the isolated post nasal drip syndrome, and from 2 control group patients without post nasal drip, by conventional light microscopy and immunohistological techniques for the protein gene product 9.5 (PGP), Neuropeptide Y (NPY), serotonin, Substance P (SP), vasoactive intestinal peptide (VIP), Calcitonin gene related peptide (CGRP) and Chromogranin A (CgA). RESULTS. The conventional light microscopy showed a very thick basal membrane, the sclerosis of small blood vessels, the hyperplasia of mucosal glands- the neurogenic inflammation, mostly in nasopharyngeal mucosa. The abundance of PGP-containing nerve fibres was found around glands, sclerotic arterioles in almost all the cases. The main neuropeptides that were found in the mucosa of the patients were VIP, NPY, CgA, mostly in the nasopharyngeal mucosa. There were differences in PGP-containing structures and the selective neuropeptide (NPY, CgA, and VIP) distribution in nasal and nasopharyngeal mucosa in comparison with the control group. CONCLUSIONS. The main histological changes in the patients with the isolated post nasal drip syndrome are a thickened basal membrane, the hyperplasia of basal cells, pronounced hyperplasia of mucosal glands, the sclerosis of small arterioles. The main neuropeptides that are found in nasal and nasopharyngeal mucosa samples are PGP 9.5, vasoactive intestinal peptide, neuropeptide Y and chromogranin in the post nasal drip syndrome group. There is an imbalance of common neuropeptide-containing innervations, mainly sympathic nerves, the precursors of neuropeptides- chromogranins in the nasopharyngeal mucosa of the patients with the post nasal drip syndrome. SP and CGRP are not the most characteristic neuropeptides in the case of the post nasal drip syndrome pathogenesis.

Chronic cough in children

Chronic cough has been variably defined as a cough lasting longer than 3, 4 or 8 weeks. Many post viral or pertussis like illnesses are associated with prolonged coughing that resolves over time. Management involves first trying to make a diagnosis and identify the presence of any underlying condition. Targeted treatments can then be employed. Trials of treatments are often used to make a diagnosis. Because natural resolution of cough is so common any trial of treatment to confirm a diagnosis should be time limited and the treatment only restarted if the coughing returns. Only a small proportion of children with an isolated non-specific dry cough have asthma and care is needed not to over diagnose asthma. Children with chronic wet cough may have protracted bacterial bronchitis (PBB) that responds to a full course of antibiotics. Children with PBB failing to respond to treatment or with specific pointers should be investigated for specific causes of suppurative lung disease.

Review: Evidence on PPIs for nonspecific chronic cough in adults with gastroesophageal reflux disease is inconsistent

Source Citation Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev. 2011;(1):CD004823. 21249664

Etiological analysis of the children with non-specific chronic cough in Fuzhou area of Fujian province

Chronic cough in children is a common pediatric symptom with complex causes and its diagnosis is difficult; chronic cough affects the life of children in both physical and mental health and also learning. Therefore this study aimed to investigate the causes of chronic cough in children in Fuzhou area of Fujian province. Data were collected from 364 children with chronic cough who visited the asthma specialist clinic of Children's Hospital of Fuzhou, Fujian Province from March 2009 to April 2010. The diagnosis was made according to Guideline for Diagnosis and Treatment of Chronic Cough in Pediatrics published in 2008. Among the patients, 241 were boys and 123 girls. The patients were divided into 3 age groups: group 1, 1 to 3 years old (infants and young children group, n = 75); group 2, 4 to 6 years old (pre-school group, n = 215); and group 3, over 7 years (school-age group, n = 74), the mean age was (4.8 ± 1.1) years (3 months to 14 years), course of the illness was (4.5 ± 1.8) months (4 weeks to 38 months). Mycoplasma pneumoniae was detected by Enzyme-linked immunosorbent assay (ELISA). The causes of chronic cough were as follows: 171 cases (46.98%) had cough variant asthma; 104 cases (28.57%) had upper airway cough syndrome; 58 cases (15.93%) had respiratory infections; 17 cases (4.67%) had gastroesophageal reflux; 3 cases (0.82%) had foreign bodies. Totally 9 cases (2.47%) had chronic cough associated with 3 causes; 56 cases (15.38%) had 2 causes and 299 cases (82.14%) had single cause. The main causes of cough in the group of pre-school children were cough variant asthma and upper airway cough syndrome. The proportion of the upper airway cough syndrome in school-age children group was the highest among the 3 age groups, which is flowed by cough variant asthma. The causes of chronic cough in children were cough variant asthma, upper airway cough syndrome, respiratory infections, cough after infection, gastroesophageal reflux and foreign bodies in Fuzhou area of Fujian province. Children with chronic cough in different age groups had different etiology, in about 18% of the children the etiology of chronic cough was associated with 3 or 2 causes, indicating that the causes of chronic cough in children are multifactorial.

Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults

Gastroesophageal reflux disease (GORD) is said to be the causative factor in up to 41% of adults with chronic cough. Treatment for GORD includes conservative measures (diet manipulation), pharmaceutical therapy (motility or prokinetic agents, H(2)-antagonist and proton pump inhibitors (PPI)) and fundoplication. To evaluate the efficacy of GORD treatment on chronic cough in children and adults with GORD and prolonged cough that is not related to an underlying respiratory disease, i.e. non-specific chronic cough. We searched the Cochrane Airways Group Specialised Register, the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, review articles and reference lists of relevant articles. The date of last search was 8 April 2010. All randomised controlled trials (RCTs) on GORD treatment for cough in children and adults without primary lung disease. Two review authors independently assessed trial quality and extracted data. We contacted study authors for further information. We included 19 studies (six paediatric, 13 adults). None of the paediatric studies could be combined for meta-analysis. A single RCT in infants found that PPI (compared to placebo) was not efficacious for cough outcomes (favouring placebo OR 1.61; 95% CI 0.57 to 4.55) but those on PPI had significantly increased adverse events (OR 5.56; 95% CI 1.18 to 26.25) (number needed to treat for harm in four weeks was 11 (95% CI 3 to 232)). In adults, analysis of H(2) antagonist, motility agents and conservative treatment for GORD was not possible (lack of data) and there were no controlled studies of fundoplication. We analysed nine adult studies comparing PPI (two to three months) to placebo for various outcomes in the meta-analysis. Using intention-to-treat, pooled data from studies resulted in no significant difference between treatment and placebo in total resolution of cough (OR 0.46; 95% CI 0.19 to 1.15). Pooled data revealed no overall significant improvement in cough outcomes (end of trial or change in cough scores). We only found significant differences in sensitivity analyses. We found a significant improvement in change of cough scores at end of intervention (two to three months) in those receiving PPI (standardised mean difference -0.41; 95% CI -0.75 to -0.07) using generic inverse variance analysis on cross-over trials. Two studies reported improvement in cough after five days to two weeks of treatment. PPI is not efficacious for cough associated with GORD symptoms in very young children (including infants) and should not be used for cough outcomes. There is insufficient data in older children to draw any valid conclusions. In adults, there is insufficient evidence to conclude definitely that GORD treatment with PPI is universally beneficial for cough associated with GORD. Clinicians should be cognisant of the period (natural resolution with time) and placebo effect in studies that utilise cough as an outcome measure. Future paediatric and adult studies should be double-blind, randomised controlled and parallel-design, using treatments for at least two months, with validated subjective and objective cough outcomes and include ascertainment of time to respond as well as assessment of acid and/or non-acid reflux.

Congenital bronchoesophageal fistula in adults

To study the clinical characteristics, diagnosis and surgical treatment of congenital bronchoesophageal fistulae in adults. Eleven adult cases of congenital bronchoesophageal fistula diagnosed and treated in our hospital between May 1990 and August 2010 were reviewed. Its clinical presentations, diagnostic methods, anatomic type, treatment, and follow-up were recorded. Of the chief clinical presentations, nonspecific cough and sputum were found in 10 (90.9%), recurrent bouts of cough after drinking liquid food in 6 (54.6%), hemoptysis in 6 (54.6%), low fever in 4 (36.4%), and chest pain in 3 (27.3%) of the 11 cases, respectively. The duration of symptoms before diagnosis ranged 5-36.5 years. The diagnosis of congenital bronchoesophageal fistulae was established in 9 patients by barium esophagography, in 1 patient by esophagoscopy and in 1 patient by bronchoscopy, respectively. The congenital bronchoesophageal fistulae communicated with a segmental bronchus, a main bronchus, and an intermediate bronchus in 8, 2 and 1 patients, respectively. The treatment of congenital bronchoesophageal fistulae involved excision of the fistula in 10 patients or division and suturing in 1 patient. The associated lung lesion was removed in all patients. No long-term sequelae were found during the postoperative follow-up except in 1 patient with bronchial fistula who accepted reoperation before recovery. Congenital bronchoesophageal fistula is rare in adults. Its most useful diagnostic method is esophagography. It must be treated surgically as soon as the diagnosis is established.

Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults

Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults

Outbreak of Pertussis in a University Laboratory

Analysis of an outbreak of Bordetella pertussis infection in a university laboratory. To prevent and control the outbreak, we conducted a survey of the laboratory staff and their family members, and we investigated the clinical features of adult pertussis. During the outbreak, four out of the 10 laboratory staff and five out of 16 family members had a primary complaint of cough. Seven of nine patients were diagnosed as definitive B. pertussis infection using serology and PCR. Clinical findings and laboratory data in adult patients with B. pertussis infection demonstrated non-specific cough and normal WBC and lymphocyte count. The patients who received clarithromycin prior to 14 days after clinical onset demonstrated a shorter duration of cough symptoms than patients who received clarithromycin at 14 days or more after clinical onset (duration of cough after administration of clarithromycin: 17.8 ± 6.48 days versus 35.3 ± 5.38 days; duration of total cough after clinical onset: 24.8 ± 6.65 days versus 56.8 ± 6.50 days). The clinical findings of adult pertussis are different from pertussis in children. The efficacy of macrolide therapy clearly differed between the catarrhal phase and paroxysmal phase. Physicians should consider B. pertussis in the differential diagnosis of an outbreak of non-specific respiratory infection even in adult populations.

The Cochrane Library and the Treatment of Chronic Cough in Children: An Overview of Reviews

AbstractBackgroundChronic cough is a universal condition of childhood that affects approximately one in ten children. Chronic cough can be either specific (‘wet’ cough or other symptoms concurrently present) or nonspecific (‘dry’ cough in the absence of other symptoms). Compared to adults, specific and non‐specific chronic cough in children differs in terms of both aetiology and treatment, and the methods used to treat chronic cough in adults may actually be harmful for children.ObjectiveThis overview of reviews synthesizes the evidence currently in the Cochrane Library Database of Systematic Reviews (CDSR) in order to answer the following question: in the treatment of childhood specific and non‐specific chronic cough, which pharmacologic or non‐pharmacologic treatments improve cough symptoms and decrease adverse events?MethodsThe Cochrane Database of Systematic Reviews was searched using the terms ‘specific cough’, ‘non‐specific cough’, ‘moist cough’ and ‘chronic cough’ in the record title for all systematic reviews examining pharmacologic or non‐pharmacologic interventions for the treatment of chronic cough in children. Data were extracted, complied into tables, and synthesized using qualitative and quantitative methods.Main ResultsSix reviews (five on non‐specific cough and one on specific cough) were indentified for inclusion. For non‐specific cough, one review found that very high‐dose inhaled corticosteroids were effective in reducing non‐specific cough (RR: 2.04; 95% CI: 1.10, 3.77), but this treatment was not advocated. To date, there is no evidence that anti‐histamines, β2 agonists, gastro‐oesophageal reflux treatments or leukotriene receptor antagonists are efficacious for the treatment of non‐specific chronic cough. For specific cough related to isolated wet cough, there was significant clinical improvement when children were treated with antibiotics (RR: 2.42; 95% CI: 1.65, 3.53). Limited data were available for adverse events associated with any of the treatment options.Authors' ConclusionsThe paucity of RCT evidence in the management of children with chronic cough is striking. Five systematic reviews on interventions for non‐specific cough do not support an empirical treatment approach. One systematic review on interventions for specific cough found some support for the use of antibiotics. Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

Rapidly Progressive Lethal Infection With Novel Influenza A (H1N1) 2009 Virus in a Kidney Recipient: A Cautionary Tale

Rapidly Progressive Lethal Infection With Novel Influenza A (H1N1) 2009 Virus in a Kidney Recipient: A Cautionary Tale

PREVALENCE AND RISK FACTORS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) IN DHAKA CITY BANGLADESH

This prospective, cross-sectional population based survey was carried out in the Respiratory wing, Department of Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh to see the prevalence and risk factors of chronic obstructive pulmonary disease (COPD) among Dhaka City Population in Bangladesh. The total sample size was 900 at the age of 35 years or above. Spirometry was performed according to ATS criteria. Data related to smoking history, respiratory symptoms, co-morbidities, physical examination findings, spirometry values and other investigation reports were noted in the questionnaire. The mean age was 45.26±10.08 (Mean±SD); of them, male 76.9% and female 23.1%. Among them, smoker was 481 with a smoking duration of 10 pack year 27.8% and non smoker were 419. Spirometric screening yielded diagnosis of COPD in 11.4% (103/900). Using operational severity criteria adopted from Global Initiative for Obstructive Lung Disease (GOLD) mild, moderate, severe and very severe COPD were found in 42.7%, 27.2%, 20.4% and 9.7% respectively. The hall mark symptom of COPD exertional dyspnea was seen in 10.4%, non-specific symptoms like cough and sputum were found in 40% and 19% respectively. Physical sign like vesicular breath sound with prolonged expiration and ronchi were found in 6.1% and 4.1% respectively. In this study, age (Mean±SD in years) (57.34±11.74), Sex (Male: Female = 4:1), low BMI (Mean±SD) (21.56±3.83), Smoker 56(20.2%) and low Socio-economic condition 54(13.6%) found to be risk factor of COPD. Regression analysis revealed that age (p<0.001), sex (p<0.001), smoking duration (p<0.001) and low socioeconomic condition (p<0.05) as independent risk factors for COPD.