To ascertain the validity of anatomic diagnostic protocol in determining etiology of chronic cough in tropics. Cost analyses to determine effective ways of managing chronic cough.
A prospective, descriptive, study of immunocompetent, non-smoking patients with chronic cough. All patients were evaluated by a validated anatomic diagnostic protocol proposed by Irwin and colleagues. The diagnostic protocol was modified to include sputum examination for acid-fast bacilli, absolute eosinophil count and stool examination. The final diagnosis was based on radiological, laboratory findings and a successful response to therapy.
Eighty-seven consecutive patients with chronic cough were evaluated from February 2000 to February 2002 using the modified diagnostic protocol. The mean age ±S.D. was 35.00±11.85 years. Forty-nine patients were males.Etiology of chronic cough determined in 86 (99%) patients. Cough resolved in 99% patients after successful diagnosis and treatment. Cough was due to multiple causes in 16%. Postnasal drip, 52%, Asthma, 41%, and Loeffler’s syndrome, 8%, were the three most common causes. Pulmonary tuberculosis was confirmed in 5% of patients. Hence 13% of patients had conditions more prevalent in the tropics. Gastroesophageal reflux disease was seen in 6%. Rare causes of chronic cough included cardiac failure. The average cost per patient was Rs 878.55 and 90% of patients were diagnosed with < Rs 1000 (1 US$=Rs 48). Using modified diagnostic protocol 90% of patients were diagnosed with minimal investigations making it cost effective.
The three most common causes of chronic cough in the tropics are different from the west. Pulmonary tuberculosis and Loeffler’s syndrome are more prevalent and need to be considered. Using the modified diagnostic protocol etiology of chronic cough can be determined successfully in tropics in most patients. A cost effective way of evaluating cough has been proposed and needs to be validated.
In tropical countries when evaluating patients with chronic cough sputum analysis for acid-fast bacilli, absolute eosinophil count and stool examination should be included in the diagnostic protocol
F.R. Nadri, None.