PURPOSE: Reasons patients with chronic cough are referred for specialist evaluation include: anxiety on the part of the patient, family, friends, or treating physician that the cough represents a serious condition, personal lifestyle disruption, cough-associated symptoms, or lack of response to treatment. Cough-associated symptoms may include sleep disruption, fatigue, syncope, retching, vomiting, stress incontinence, or chest pain. The aim of the current study was to determine the prevalence of post nasal drip syndrome and cough-associated symptoms.
METHODS: Patients, referred with cough of greater than one month's duration, completed a cough-specific quality of life questionnaire. Abnormal chest radiographs or systemic symptoms, such as fever, night sweats, or weight loss, dyspnea, hemoptysis, a history of cancer, tuberculosis, or other underlying respiratory disease were exclusions.
RESULTS: 108 consecutive patients were surveyed. Median age was 47 years (range 18 to 79 years) and 71% were female. Median cough duration was 49 months (range 2 to 360 months). Most had one or more trials of various asthma inhalers and proton pump inhibitors but only a few had trials of nasal sprays prior to referral. 49% had concerns of a serious underlying disease such as cancer, tuberculosis or another serious infection causing their cough. 48% experienced sleep disruption, 49% retching, 22% vomiting, and 42% of the women complained of stress incontinence. The majority of patients complained of nasal symptoms-nasal stuffiness, coryza, drainage down the back of their throat. Treatment included saline (85%), ipratropium (16%), or corticosteroid (6%) nasal sprays; corticosteroid (ICS) or combination ICS/LABA inhalers (18%), and proton pump inhibitors (12%). Cough disappeared or improved in 77% of the patients eight weeks after initial assessment.
CONCLUSION: Eight weeks after initial specialist assessment, most patients in this cohort experienced an improvement in their cough and in cough-associated symptoms.
CLINICAL IMPLICATIONS: Community physicians appreciate that asthma and gastroesophageal reflux can cause cough; however this study highlights that postnasal drip syndrome is less well recognized as an important cause.
DISCLOSURE: Stephen Field, No Financial Disclosure Information; No Product/Research Disclosure Information