Introduction and objectives In the past, some respiratory centres reported success rates of 98% when treating chronic cough based on identifying and treating underlying conditions such as asthma, nasal disease and gastro-oesophageal reflux. However, cases refractory to treatment of potential underlying causes are increasingly recognised, especially in specialist services. A hyper-responsiveness of the neuronal pathways controlling cough is thought to be the primary problem in these patients and antitussives targeting neuronal activity are most likely to be effective.
Methods A retrospective analysis of electronic notes at the Manchester University NHS Foundation Trust tertiary cough clinic was performed to identify treatment responses to conditions thought to be driving chronic cough.
Results We reviewed 300 electronic case notes of new patients seen between May 2015 and Sep 2016. After excluding those with incomplete records, lost to follow-up and still undergoing investigation, we analysed 276 chronic cough referrals (mean age 57.4 years, 65.6% female).
Cough spontaneously resolved in 14 (5.1%) cases. Ninety-nine (35.9%) had a cause identified, treatment of which lead to an improvement in cough. However, of these 99, treatment response was unsatisfactory in 53 (19.2%), who went on to trial antitussive therapies for cough hypersensitivity syndrome. Of the 46 (16.7%) with a profound treatment response, the most common underlying diagnoses were asthma (12, 4.3%), reflux (10, 3.6%) and bronchiectasis (6, 2.2%). Overall, 15 different underlying diagnoses contributing to cough were identified, the treatment of which improved cough.
The remaining 163 (59.1%) patients either had no identifiable underlying diagnosis or did not respond to treatment trials of identified conditions, but had similar characteristics to the main cohort (mean age 57.5 years, 66.9% female).
Conclusions The aetiology of chronic cough at our tertiary cough clinic has a very different complexion to that reported in the literature. A variety of different conditions were found to contribute to cough but the majority had either no response or an inadequate response to standard therapies. Efforts must be focused on expanding the treatment options available for refractory chronic cough.
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