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Chronic persistent cough. Experience in diagnosis and outcome using an anatomic diagnostic protocol
R H Poe1, R V Harder, R H Israel
1Department of Medicine, Highland Hospitals, Rochester, New York 14620.
Chest
|April 1, 1989
Summary
This study evaluated Irwin's cough diagnosis and treatment method in 139 patients. While effective for hyperreactive airways (HA), the approach showed lower success rates for other cough causes, suggesting limitations in its broad applicability.
Area of Science:
- Pulmonology
- Respiratory Medicine
- Clinical Diagnosis
Background:
- A previously reported anatomic approach by Irwin et al. demonstrated high success rates for diagnosing and treating cough.
- This study aimed to validate the efficacy of this approach in a community hospital setting.
Purpose of the Study:
- To assess the effectiveness of Irwin's anatomic approach for cough diagnosis and treatment in a consecutive series of patients referred to pulmonary specialists.
- To compare the outcomes with those originally reported by Irwin and co-workers.
Main Methods:
- A review of 139 consecutive patients with cough referred to community hospital pulmonary specialists.
- Diagnosis involved identifying hyperreactive airways (HA) via carbachol inhalation or eucapnic cold air hyperventilation, and assessing for other causes like postnasal drip and upper airway inflammation.
- Treatment was adjusted for compliance, and outcomes were retrospectively evaluated.
Main Results:
- A specific cause for cough was identified in 88% of patients.
- Hyperreactive airways (HA) were diagnosed in 39 patients, all of whom improved with treatment.
- Other diagnoses included postnasal drip (27/78), persistent cough post-upper airway inflammation (13/78), chronic bronchitis, GERD, and others.
- While HA patients improved, 8% of patients without HA or a specific diagnosis did not show cough improvement.
Conclusions:
- Irwin's anatomic approach successfully identified the cause of cough in a high percentage of patients (88%).
- Treatment was highly effective for patients with hyperreactive airways (HA).
- The overall success rate for diagnosis and treatment of cough may not be as consistently high as initially reported, particularly for non-HA causes.