To study the epidemiology of chronic cough in patients who have failed earlier treatment in a primary healthcare setting.
A prospective study was conducted on patients with cough for 3 or more weeks referred to our specialist cough clinic over a 6 month period in year 2004. A total of 112 patients with normal Chest Xray were recruited. Patients’ cough severity was assessed using a cough symptom score (score of 1 to 8 based on severity of daytime and nocturnal cough) before and after treatment. All patients were subjected to a standardized protocol for history taking, examination, investigations and treatment. Investigations included rhinoscopy, spirometry or methacholine challenge test, skin prick test, thoracic and sinus imaging when appropriate. Patients were started on empiric gastroesophageal reflux (GERD) treatment when no other obvious causes of cough were found. A protocol for pH monitoring in the event of poor response to GERD treatment was in place.
Median age of our patients was 48 years (range 14 to 86) and median cough duration was 12 weeks (range 3 to 416). The mean cough score at 1st consultation was 3.9 ± 1.2 and 59 patients (49%) had a cough score of 4 at the 1st consult. At the end of the treatment period, 13.6% of the patients were diagnosed to have asthma, 46.6% had post-nasal drip and 47.7% had GERD. Eighty-six patients (90.5%) reported improvement to treatment. The median time taken for symptom improvement or resolution (final cough score 0 or 1) was 28 days (range 7 to 256).
GERD and post-nasal drip were the 2 most common causes of chronic cough in patients treated in our specialist cough clinic. Though common, they were not identified and treated promptly in the primary healthcare setting.
A greater awareness of GERD and post-nasal drip as conditions resulting in chronic cough should be promoted in the primary healthcare setting. Although diagnosis of these conditions were delayed, they responded well to appropriate treatment.
Wee Yang Pek, None.