BACKGROUND AND OBJECTIVE: A prospective study was conducted to investigate the efficacy of empirical therapy in the management of chronic cough. METHODS: A three-step empirical therapy protocol was used to treat patients who had a chronic cough and a normal CXR and normal lung function testing. In step one antihistamine decongestants plus bronchodilators were taken, corticosteroids in the second step, and a combination of a proton pump inhibitor and a prokinetic agent in the third step. Cough symptom scores were recorded before and after each step in the protocol. RESULTS: There were 102 patients recruited; mean age 49 +/- 16 years and with a history of cough of between 2 and 120 months at presentation. The cough resolved in 67.6% (n = 69) of the patients after the first-step therapy; in a further 12.7% (13) after the second-step therapy, and in another 7.8% (8) after the third-step of the treatment protocol. In three patients cough improved after the first-step of therapy but only achieved complete resolution when this treatment was combined with the third-step therapy. Overall, the three-step empirical therapy was successful in 88.2% (n = 90) of the patients. Cough symptom scores decreased from 3.30 +/- 0.75 to 0.30 +/- 0.97 (P < 0.001). The mean duration of treatment was 2.70 +/- 1.52 weeks (range 1-12). Cough was controlled in <4 weeks in 79.4% (n = 81) of patients. CONCLUSIONS: Three-step empirical therapy seemed to be useful in most patients and has practical application in the management of chronic cough.
BACKGROUND AND OBJECTIVE: A prospective study was conducted to investigate the efficacy of empirical therapy in the management of chronic cough. METHODS: A three-step empirical therapy protocol was used to treat patients who had a chronic cough and a normal CXR and normal lung function testing. In step one antihistamine decongestants plus bronchodilators were taken, corticosteroids in the second step, and a combination of a proton pump inhibitor and a prokinetic agent in the third step. Cough symptom scores were recorded before and after each step in the protocol. RESULTS: There were 102 patients recruited; mean age 49 +/- 16 years and with a history of cough of between 2 and 120 months at presentation. The cough resolved in 67.6% (n = 69) of the patients after the first-step therapy; in a further 12.7% (13) after the second-step therapy, and in another 7.8% (8) after the third-step of the treatment protocol. In three patients cough improved after the first-step of therapy but only achieved complete resolution when this treatment was combined with the third-step therapy. Overall, the three-step empirical therapy was successful in 88.2% (n = 90) of the patients. Cough symptom scores decreased from 3.30 +/- 0.75 to 0.30 +/- 0.97 (P < 0.001). The mean duration of treatment was 2.70 +/- 1.52 weeks (range 1-12). Cough was controlled in <4 weeks in 79.4% (n = 81) of patients. CONCLUSIONS: Three-step empirical therapy seemed to be useful in most patients and has practical application in the management of chronic cough.
Authors: Cynthia T French; Rebecca L Diekemper; Richard S Irwin; Todd M Adams; Kenneth W Altman; Alan F Barker; Surinder S Birring; Fiona Blackhall; Donald C Bolser; Louis-Philippe Boulet; Sidney S Braman; Christopher Brightling; Priscilla Callahan-Lyon; Brendan J Canning; Anne B Chang; Remy Coeytaux; Terrie Cowley; Paul Davenport; Rebecca L Diekemper; Satoru Ebihara; Ali A El Solh; Patricio Escalante; Anthony Feinstein; Stephen K Field; Dina Fisher; Cynthia T French; Peter Gibson; Philip Gold; Michael K Gould; Cameron Grant; Susan M Harding; Anthony Harnden; Adam T Hill; Richard S Irwin; Peter J Kahrilas; Karina A Keogh; Andrew P Lane; Kaiser Lim; Mark A Malesker; Peter Mazzone; Stuart Mazzone; Douglas C McCrory; Lorcan McGarvey; Alex Molasiotis; M Hassan Murad; Peter Newcombe; Huong Q Nguyen; John Oppenheimer; David Prezant; Tamara Pringsheim; Marcos I Restrepo; Mark Rosen; Bruce Rubin; Jay H Ryu; Jaclyn Smith; Susan M Tarlo; Anne E Vertigan; Gang Wang; Miles Weinberger; Kelly Weir Journal: Chest Date: 2015-07 Impact factor: 9.410
Authors: Peter J Kahrilas; Kenneth W Altman; Anne B Chang; Stephen K Field; Susan M Harding; Andrew P Lane; Kaiser Lim; Lorcan McGarvey; Jaclyn Smith; Richard S Irwin Journal: Chest Date: 2016-09-07 Impact factor: 9.410