title: [Management of chronic cough in high volume medical offices: efficacy of a sequential protocol].
abstract: BACKGROUND
  Chronic cough is one of the main causes of medical consultation. There is not however an homogeneous attitude regarding its management. A prospective evaluation was performed of a simple therapeutic protocol based on the anatomical approach of the cough reflex.
  
  
  METHODS
  A total of 110 patients with chronic cough for longer than four weeks were studied. The exclusion criteria were: non-smoking during the last year, not to have diseases compromising the immune system and not to have received inhibitors of the angiotensing converting enzyme. A three-visit stepwise approach was performed with specific diagnostic tests ordered and a specific therapy instituted according to the clinical suspicion.
  
  
  RESULTS
  At the third visit, 97% of patients were free from cough or had improved markedly. Cough causes were identified in 105 cases (95%) and the most common were: asthma (33%), postnasal dripping (29%), gastroesophageal reflux (10%), and asthma with associated gastroesophageal reflux (16%). Patients with asthma had a longer duration of tos compared with those who had postnasal dripping (p < 0.05) as the only differential feature.
  
  
  CONCLUSIONS
  The diagnostic-therapeutic diagram based on the anatomic reflex of cough is useful for the management of chronic cough in a highly demanded medical office. With this protocol, the cause of cough can be identified and treated successfully in almost every patient with a small number of diagnostic tests and medical visits.
authors.affiliation: Servicios de Neumología y Otorrinolaringología, Hospital Miguel Servet y Departamento de Medicina y Psiquiatría, Universidad de Zaragoza.
authors.forename: J
authors.initials: J
authors.lastname: Alonso Muñoz
authors.forename: B
authors.initials: B
authors.lastname: Gallego Carrión
authors.forename: S J
authors.initials: SJ
authors.lastname: Carrizo Sierra
authors.forename: E
authors.initials: E
authors.lastname: Vicente González
authors.forename: J M
authors.initials: JM
authors.lastname: Marín Trigo
mesh_terms: D000328:Adult; D001249:Asthma / Q000175:diagnosis; D002908:Chronic Disease; D003371:Cough / Q000209:etiology / Q000628:therapy; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies