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Communications to the Editor |

Chronic Cough Revisited FREE TO VIEW

Terrance W. Paul, MD
Author and Funding Information

University of Alberta Edmonton, Canada

Correspondence to: Terrance W. Paul, MD, Division of Pulmonary Medicine, Department of Medicine, 2E4.27 Walter C. Mackenzie, University of Alberta, Health Sciences Centre, Alberta AB, Canada T6G 2R7



Chest. 2000;118(1):278-279. doi:10.1378/chest.118.1.278-a
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To the Editor:

I read with interest the article by Palombini et al (August 1999).1 As the authors indicate, chronic cough is very common and may adversely affect the quality of life of many patients. The addition of rhinoscopy, sinus high-resolution CT (HRCT), and chest HRCT in the workup had a good deal of merit. Their attempts to validate the presumptive diagnoses by a trial of treatment is noteworthy.

The authors have collected a large amount of data, and reexamining it may be very enlightening. The study used history, physical examination, and diagnostic tests to evaluate cough and then validated the underlying diagnosis with specific treatment. It would be of interest to give the sensitivity, specificity, and predictive values of each of these components for the specific cause of cough. For instance, it would be valuable to know how well their symptom complex of“ heartburn, burning, and/or a sour taste in the mouth” actually predicted cough secondary to gastroesophageal reflux disease (GERD). Likewise, it would be important to know the predictive values of their various diagnostic tests for the individual diagnoses. How valuable is rhinoscopy in diagnosing the cause of chronic cough when one has postnasal drip?

Unfortunately, this information cannot be found in this publication. The reader is uncertain as to what the authors’ wish to communicate in their Table 1, where the sensitivity and specificity for various diagnostic tests are presented. According to the article, carbachol inhalational challenge has a sensitivity of 100% as a diagnostic test for cough. Given what diagnosis? Surely not in GERD. The information necessary to interpret their Table 1 is not communicated anywhere in the article.

The authors have once again highlighted asthma, postnasal drip, and GERD as important causes of chronic cough. By their own admission, they employed more tests than other studies,24 but achieved a similar therapeutic success rate. The study, as it stands now, has added little to what we already knew about chronic cough. It behooves the authors to take that next step and construct an approach to this common symptom using their diagnostic criteria, and then validate that approach prospectively.

References

Palombini, BC, Villanova, CAC, Araujo, E, et al (1999) A pathogenic triad in chronic cough.Chest116,279-284. [CrossRef]
 
Irwin, RS, Corrao, WM, Pratter, RM Chronic cough: the spectrum and frequency of causes, key components of diagnostic evaluation, and outcome of specific therapy.Am Rev Respir Dis1990;141,640-647. [CrossRef]
 
Pratter, MR, Bartter, T, Akers, S, et al An algorithmic approach to chronic cough.Ann Intern Med1993;119,977-983. [CrossRef]
 
Poe, RH, Israel, RH Evaluating and managing that nagging chronic cough.J Respir Dis1990;11,297-313
 

Figures

Tables

References

Palombini, BC, Villanova, CAC, Araujo, E, et al (1999) A pathogenic triad in chronic cough.Chest116,279-284. [CrossRef]
 
Irwin, RS, Corrao, WM, Pratter, RM Chronic cough: the spectrum and frequency of causes, key components of diagnostic evaluation, and outcome of specific therapy.Am Rev Respir Dis1990;141,640-647. [CrossRef]
 
Pratter, MR, Bartter, T, Akers, S, et al An algorithmic approach to chronic cough.Ann Intern Med1993;119,977-983. [CrossRef]
 
Poe, RH, Israel, RH Evaluating and managing that nagging chronic cough.J Respir Dis1990;11,297-313
 
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