Objectives:
To evaluate a stepwise approach to chronic cough that emphasized initial treatment of all patients with an antihistamine-decongestant for postnasal drip and to determine the value of routine bronchoprovocation challenge in the evaluation of chronic cough.
Design:
Prospective trial using an algorithm for chronic cough in immunocompetent nonsmoking outpatients.
Setting:
University-based pulmonary practice.
Patients:
Forty-five patients met the inclusion criteria. The mean duration of cough was 140 weeks (range, 3 to 2080 weeks), and the mean severity of cough as assessed by patients on a four-point scale was severe.
Results:
Marked improvement and resolution (mean, 3.1 and 7.1 weeks, respectively), with resolution in 96% of patients. Antihistamine-decongestant therapy was beneficial in 39 of 45 patients and was the only therapy needed for 16 patients. Bronchoprovocation challenge had a negative predictive value of 100% and a positive predictive value of 74% for cough caused by asthma. No significant relationship was found between the time to cough resolution and duration or severity of cough. Eighteen percent of patients experienced a recurrence of cough at a follow-up interval of 3 months.
Conclusions:
A sequential approach to chronic cough that emphasizes initial treatment with an antihistamine-decongestant is effective. Bronchoprovocation challenge is useful in evaluating patients with chronic cough but can be delayed until the initial response to antihistamine-decongestant therapy has been assessed. The 18% incidence of recurrence highlights the fact that cough often is the manifestation of a chronic or recurring process that requires chronic or episodic therapy.
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Author, Article, and Disclosure Information
From Cooper Hospital/University Medical Center, UMDNJ/Robert Wood Johnson Medical School at Camden, Camden, New Jersey.
Corresponding Author: Melvin R. Pratter, MD, Suite 312, 3 Cooper Plaza, Camden, NJ 08103.
Acknowledgments: The authors thank Gary Young and Patricia Gregory for statistical support.
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