Initial empirical treatment based on clinical feature of chronic cough

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Abstract

Background:

An empirical therapy based on the clinical characteristics of cough had not been reported. We evaluated this strategy of empirical therapy on chronic cough.

Methods:

Patients with chronic cough were initially diagnosed with corticosteroid-responsive cough (CRC), postnasal drip syndrome (PNDS) and gastroesophageal reflux-related cough (GERC) based on their medical history and clinical presentation, and received a sequential three-step empirical therapy. A successful response was required for final diagnosis.

Results:

A total of 96 patients were recruited with a median duration of cough for 4 months (range, 2–100). The primary diagnosis based on history and clinical presentation was CRC in 53 patients (55.2%), PNDS in 36 (37.5%) and GERC in 7 (7.3%). Cough improved in 60 patients (62.5%) at the first step with mean time of 6.2 ± 3.3 days. Three-step empirical therapy was beneficial in 78 of 96 (81.2%) patients at last. The final spectrum and frequency of causes of cough based on therapeutic response were as follows: CRC (46.7%), PNDS (27.5%) and GERC (10.8%). Eighteen cases (18.8%) were not responsive to empirical treatment, seven of whom were identified as other causes by diagnostic tests.

Conclusions:

The empirical therapy aimed at primary diagnosis on the basis of history and clinical characteristics is a more targeted approach, and leads to improvement of chronic cough more quickly in most patients. CRC is the most common cause of chronic cough.

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