1. Evaluate current approaches to evaluation and management of chronic cough. 2. Assess frequency of sleep disorders in patients with chronic cough and the impact of treatment for OSA on the resolution of chronic cough.
Retrospective evaluation of clinical data of patients with chronic cough seen over a 3-year period in 8-provider pulmonary practice was done. Patients with abnormal PFTs or chest X-rays, known asthma, chronic lung disease and CHF were excluded.
Data on 63 patients (38 females; 25 males) was reviewed. Mean age was 58 years with an average BMI of 31.3. The diagnostic approach included chest X-rays in 68%, PFTs in 87%, and chest CT scans in 13%. New diagnoses of OSA was made in 15 out of the 35 patients evaluated for sleep problems. The most common etiologies were gastro-esophageal reflux (GERD), upper airway cough syndrome (UACS), OSA and asthma (Figure 1). 29/63 patients had multiple etiologies for cough (Figure 2). Of the 26 patients with chronic cough and new or previously diagnosed OSA, 19 showed improvement with addition or retitration of their nocturnal CPAP.
Significant variation exists in evaluation of chronic cough between pulmonologists. Nearly half of these patients are treated for multiple etiologies, especially for GERD and UACS. Given the empiricism in therapy, marked variations exist in treatments apart from novel therapries such as prolonged courses of azithromycin. No patients were diagnosed with chronic eosinophilic bronchitis despite a 10% prevalence of this problem in larger studies. In those assessed for sleep-disordered breathing, a significant proportion of patients were newly diagnosed with obstructive sleep apnea or had changes in their nocturnal positive pressure therapy.
Depsite the development of ACCP guidelines, significant variations occur in the diagnostic and therapeutic approach to chronic cough. The benefit of novel therapies such as prolonged courses of azithromycin need to be tested prospectively. Even more important, the role of OSA in the predisposition and perpetuation of chronic cough needs to be addressed prospectively.
Sarah Daly, No Financial Disclosure Information; No Product/Research Disclosure Information