Signs and Symptoms of Chest Diseases: Cough |

Comparison of Efficacy of Sequential Empirical Three-Step Therapy for Chronic Cough Among Different Grades of Hospitals FREE TO VIEW

Yu Li, MD; Xianghuai Xu, MD; Qiang Chen, MD; Hanjing Lv, MD; Zhongmin Qiu, MD
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Tongji Hospital, Tongji University School of Medicine, Shanghai, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A544. doi:10.1016/j.chest.2016.02.568
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: The purpose of the study is to demonstrate the applicability of the therapeutic strategy in the different grades of hospitals.

METHODS: Sequential empirical three-step therapy was given to the patients with chronic cough in respiratory clinics of one tertiary hospital and three second care hospitals respectively. Recruiters were initially treated with methoxyphenamine compound as first-step therapy, followed by corticosteriods as second-step therapy and the combination of a proton pump inhibitor and a prokinetic agent as third-step therapy. The efficacy of the therapy was verified according to the changes in cough symptom score before and after treatment, and compared among the different grades of hospitals.

RESULTS: 155 patients in one tertiary hospital and 152 patients in second care hospitals were recruited into study. Total lost follow-up ratio is significantly higher in second care hospitals than that in the tertiary hospital (8.6% vs 3.2%, x2= 3.928, P= 0.047). The therapeutic success rate for cough was 38.7% (controlled in 31 and improved in 29 patients) at first-step therapy, 32.3% (controlled in 26 and improved in 24 patients) at second-step therapy and 20.0% (controlled in 8 and improved in 23 patients) at third-step therapy in the tertiary hospital. It was comparable to corresponding 50.0% (controlled in 30 and improved in 46) at first-step therapy, 30.9% (controlled in 21 and improved in 26) at second-step therapy and 3.9% (controlled in 2 and improved in 9 patients) at third-step therapy in second care hospitals respectively. Furthermore, the overall cough resolution rate was not significantly different (91.0% vs 84.9%, x2= 1.052, P= 0.305). However, the efficacy of the third-step therapy is higher (20.0% vs 3.9%, x2= 18.657, P= 0.000) in the tertiary hospital than in the second care hospitals.

CONCLUSIONS: Sequential empirical three-step therapy for chronic cough is similarly useful in different-grades of hospitals.

CLINICAL IMPLICATIONS: Sequential empirical three-step therapy is a useful strategy for the management of chronic cough.

DISCLOSURE: The following authors have nothing to disclose: YU Li, Xianghuai Xu, Qiang Chen, Hanjing Lv, Zhongmin Qiu

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