Chest
Clinical InvestigationsAsthmaA Pathogenic Triad in Chronic Cough: Asthma, Postnasal Drip Syndrome, and Gastroesophageal Reflux Disease
Section snippets
Materials and Methods
The protocol for this study was approved by the Hospital Ethics Committee, and all patients gave their informed consent. This was a prospective, descriptive study of consecutive, unselected, immunocompetent patients who were referred to our university outpatient clinic for the evaluation of chronic cough. All patients were evaluated using a previously published diagnostic protocol.45678
Results
Seventy-eight patients were studied: 27 were male (36%) and 51 were female (64%). The mean ± SD age was 57 ± 16.7 years (range, 15 to 81 years). The mean ± SD history of cough was 72 ± 96.4 months (range, 1 to 480 months). The mean ± SD number of physicians previously seen was 7.4 ± 8.8 per patient. A total of 666 diagnostic tests were performed (mean, 8.5 tests per patient). A diagnosis was established in all 78 patients. The therapeutic success rate was 93.6%, ie, 73 of the patients who
Discussion
Several published studies of the differential diagnosis of chronic cough have employed similar protocols.456782425262728 These studies included chest radiography, sinus radiography, pulmonary function tests, methacholine inhalational challenge, biochemical laboratory tests, BRONCH, and esophageal pH monitoring. In the present study, we added RHINOS, sinus HRCT, and chest HRCT. We believe that RHINOS should be included routinely, as recent articles in the literature have quoted the presence of
Conclusion
Several conclusions regarding the study of chronic cough appear to be important based on our findings.
The concept of an anatomic protocol focused on evaluating the location of receptors and afferent pathways of coughing is still valid. The five most important causal factors of chronic cough were asthma, PNDS, GERD, BRO, and TRCOL. These conditions were responsible for 96.2% of cases of chronic cough. Single causes of coughing were present in 38.5% of cases in the series, and we were surprised
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Presented in part at the annual meeting of the American Thoracic Society, New Orleans, LA, May 10, 1996.
Supported in part by Fundação de Amparo à Pesquisa do Rio Grande do Sul, Brazil.