Clinical benefit of sequential three-step empirical therapy in the management of chronic cough.
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.
Yu
Li
L
Department of Respiratory Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
Qiu
Zhongmin
Z
Lü
Hanjing
H
Wei
Weili
W
Shi
Cuiqin
C
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D003371:Cough / Q000188:drug therapy* / Q000503:physiopathology; D004359:Drug Therapy, Combination; D036262:Empirical Research; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects / Q000502:physiology; D006634:Histamine H1 Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D006634:Histamine H1 Antagonists; D054328:Proton Pump Inhibitors