Prevalence of chronic cough is 5-40% worldwide.According to a Brazilian study published the Annals of Allergy, Asthma, and Immunology, high-dose inhaled beclomethasone used for short period of time (2 weeks) led to an excellent response in patients with chronic cough.
All patients included in the study had methacholine bronchoprovocation testing and allergy skin prick testing. Average cough duration was 20 weeks. Half of patients in each group (treatment group and placebo) had positive bronchoprovocation and skin test results.
According to the authors, high-dose inhaled beclomethasone provided an excellent response in patients with chronic cough that did not correlate with atopy or airway hyperresponsiveness.
Differential diagnosis of cough, a simple mnemonic is GREAT BAD CAT TOM. Click here to enlarge the image: (GERD (reflux), Laryngopharyngeal Reflux (LPR), Rhinitis (both allergic and non-allergic) with post-nasal drip (upper airway cough syndrome), Embolism, e.g. PE in adults, Asthma, TB (tuberculosis), Bronchitis, pneumonia, pertussis, Aspiration, e.g foreign body in children, Drugs, e.g. ACE inhibitor, CF in children, Cardiogenic, e.g. mitral stenosis in adults, Achalasia in adults, Thyroid enlargement, e.g. goiter, "Thoughts" (psychogenic), Other causes, Malignancy, e.g. lung cancer in adults).
References:
High-dose inhaled beclomethasone treatment in patients with chronic cough: a randomized placebo-controlled study. Marcos Ribeiro; Carlos Alberto de Castro Pereira; Luiz E. Nery; Osvaldo Shigueomi Beppu; Clystenes O. S. Silva. Annals of Allergy, Asthma and Immunology, Vol. 99, No. 1, pp.61-68, 07/2007.
Inhaled Beclomethasone Can Be Effective for Chronic Cough. Medscape, 08/2007.
Long-term low-dose erythromycin in patients with unexplained chronic cough: no effect http://goo.gl/8eOUS
Diagnosis of chronic cough in children
A 2-week course of amoxycillin clavulanate achieves cough resolution in children with chronic wet cough, supporting the diagnosis of protracted bacterial bronchitis (PBB, http://goo.gl/4Vmtd).
Image source: Wikipedia, public domain.
Chronic Cough - COLA video lecture http://bit.ly/URcUQa:
Clinical approach from the concept of cough hypersensitivity - figure: http://buff.ly/1Jej9Cq
No comments:
Post a Comment