Chest
Clinical InvestigationsChronic Persistent Cough: Experience in Diagnosis and Outcome Using an Anatomic Diagnostic Protocol
Section snippets
METHODS
The medical records of all patients with chronic cough referred to the Pulmonary Disease Units at Highland and St. Mary's Hospitals, Rochester, NY, over a five-year period ending December 1986 were reviewed. The two hospitals function both as community hospitals and referral centers for the surrounding region. Patients were selected for study if (1) persistent cough was the only presenting symptom, (2) was not associated with hemoptysis, (3) had been present for at least eight weeks, (4) there
RESULTS
One hundred and thirty nine patients met the criteria for study. There were 55 men and 84 women, 19 to 79 years of age, mean age 44.8 years. One hundred and seventeen underwent carbachol and/or EHCA challenge testing. One hundred of the 117 were challenged by carbachol, 14 by cold air, and three by both. Thirty nine of the 117 patients (33 percent) demonstrated HA; 78 (67 percent) had a negative challenge result including three patients who had a negative response to both carbachol and EHCA
DISCUSSION
We were able to establish a specific cause for chronic persistent cough in the majority of patients using a diagnostic protocol similar to that previously described by Irwin et al.2 Nevertheless, 16 (12 percent) patients had a cough that remained undiagnosed despite extensive diagnostic efforts. Thirteen were available for follow-up. All had negative inhalation challenge tests. In nine of the 13, the cough eventually disappeared spontaneously or substantially improved with nonspecific cough
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Manuscript received July 14; revision accepted September 30.