An algorithmic approach to chronic cough.
OBJECTIVE
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.


METHODS
Prospective trial using an algorithm for chronic cough in immunocompetent nonsmoking out-patients.


METHODS
University-based pulmonary practice.


METHODS
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.
Pratter
M R
MR
Division of Pulmonary and Critical Care Medicine, Cooper Hospital/University Medical Center, UMDNJ/Robert Wood Johnson Medical School at Camden 08103.
Bartter
T
T
Akers
S
S
DuBois
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001249:Asthma / Q000150:complications / Q000175:diagnosis; D001985:Bronchial Provocation Tests; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003371:Cough / Q000209:etiology* / Q000517:prevention & control; D003533:Cyproheptadine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004338:Drug Combinations; D004809:Ephedrine / Q000627:therapeutic use; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis; D012220:Rhinitis / Q000150:complications; D012852:Sinusitis / Q000150:complications; D013577:Syndrome
D004338:Drug Combinations; D003533:Cyproheptadine; C006656:azatadine; D004809:Ephedrine