University of Alberta
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
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
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 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,2–4 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
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