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Introduction: Cough is a major symptom of respiratory and some non-respiratory ailments for which patients usually seek primary medical care. Homoeopathy is frequently used for treatment of chronic cough. Objective: This study aims to assess whether homoeopathy is useful for treating chronic cough resulting from Upper airway cough syndrome (UACS), Asthma and related syndromes, or Gastroesophageal reflux disease (GERD). Study Design: A multi-centre, prospective, observational cohort study was design. Study setting: The study was conducted in the outpatient departments of 10 centres of Central Council for Research in Homoeopathy, India from May 2018 - June 2020. Patients: The study enrolled patients of any gender, between 7-65 years of age, presenting cough lasting >8 weeks. Main Outcome Measure(s): Cough Severity Index (CSI) and EQ-5D-5L scales were used to analyse the outcomes. Results: Out of 2397 patients screened, only 706 cases with minimum four follow ups were studied on modified Intention to Treat (mITT) basis. The outcomes of the study were analysed by CSI and EQ-5D-5L scores. The mean of the CSI score at baseline was 19.09 while it reduced to 3.89 in the eighth follow-up with p value p-value<0.05. Phosphorus, Arsenic album, Pulsatilla, Sulphur, Lycopodium and Silica were found to be the most often prescribed medicines. [ABSTRACT FROM AUTHOR]

Upper airway cough syndrome (UACS) is a common cause of chronic cough characterized by upper airway symptoms, including nasal discharge and throat discomfort. Empirical treatments for UASC-induced chronic cough, such as first-generation antihistamines, have been used; however, the long-term use of these medicines has adverse effects. Therefore, we evaluate the efficacy, safety, and economic feasibility of Wolbigachul-tang (WBGCT), an herbal medication for UASC-induced chronic cough. This is a randomized, double-blind, active-comparator-controlled, parallel, and exploratory clinical trial. Thirty patients with UASC-induced chronic cough will be recruited and randomly allocated to the WBGCT and control groups in a 1:1 allocation ratio. The investigational medicine will be administered three times per day for 2 weeks (3 g of WBGCT at a time). The primary outcome measure is the cough symptom score measured at screening, before starting the trial, and after 2 and 4 weeks. Secondary outcome measures include the cough visual analog scale, nasal discharge score, questionnaire of clinical symptoms of cough and sputum, Leicester cough questionnaire-Korean version, integrative medicine outcome scale, integrative medicine patient satisfaction scale, and 5-level EuroQol 5-dimensional questionnaire, which will be assessed before starting the trial and after 2 and 4 weeks. This study aims to investigate the efficacy, safety, and economic feasibility of WBGCT in the treatment of chronic cough. Therefore, the results of this trial provide evidence for the application of WBGCT in the treatment of UACS-induced chronic cough. [ABSTRACT FROM AUTHOR]

Upper airway cough syndrome (UACS) is a common cause of chronic cough characterized by upper airway symptoms, including nasal discharge and throat discomfort. Empirical treatments for UASC-induced chronic cough, such as first-generation antihistamines, have been used; however, the long-term use of these medicines has adverse effects. Therefore, we evaluate the efficacy, safety, and economic feasibility of Wolbigachul-tang (WBGCT), an herbal medication for UASC-induced chronic cough. This is a randomized, double-blind, active-comparator-controlled, parallel, and exploratory clinical trial. Thirty patients with UASC-induced chronic cough will be recruited and randomly allocated to the WBGCT and control groups in a 1:1 allocation ratio. The investigational medicine will be administered three times per day for 2 weeks (3 g of WBGCT at a time). The primary outcome measure is the cough symptom score measured at screening, before starting the trial, and after 2 and 4 weeks. Secondary outcome measures include the cough visual analog scale, nasal discharge score, questionnaire of clinical symptoms of cough and sputum, Leicester cough questionnaire-Korean version, integrative medicine outcome scale, integrative medicine patient satisfaction scale, and 5-level EuroQol 5-dimensional questionnaire, which will be assessed before starting the trial and after 2 and 4 weeks. This study aims to investigate the efficacy, safety, and economic feasibility of WBGCT in the treatment of chronic cough. Therefore, the results of this trial provide evidence for the application of WBGCT in the treatment of UACS-induced chronic cough.

Introduction: The prevalence of chronic cough increases with age. However, data on the prevalence and background disorders of cough subtypes in the elderly are scarce. The objective of this study was to identify the point prevalence and risk factors of acute, subacute, and chronic cough in an elderly community-based population. Methods: This was a cross-sectional email survey amongst 26,205 members of the Finnish Pensioners' Federation during the COVID-19 pandemic in spring 2021. Results: The response rate was 23.6% (6189). 5983 subjects aged at least 64 years were included in the analyses (mean 72.6 years, 66.3% female). The point prevalence of daily acute, subacute, and chronic cough were 1.4%, 0.7%, and 9.6%, respectively. Only 0.4% of the subjects had a COVID-19 infection. In the multivariate analyses, chronic rhinosinusitis, and obstructive sleep apnoea were common risk factors for all cough subtypes. Chronic cough had several risk factors; Bronchiectasis (OR 5.79 (CI95% 2.70–12.41)), current asthma (2.67 (2.02–3.54)), chronic rhinosinusitis (2.51 (1.94–3.24)), somatic symptom score (1.13 per symptom (1.07–1.19)), family history of chronic cough (1.88 (1.54–2.30)), gastro-oesophageal reflux disease (1.86 (1.50–2.32)), advanced age (1.20 per decade (1.02–1.40)), chronic obstructive pulmonary disease (1.74 (0.99–3.05)), dog ownership (1.42 (1.07–1.89)), and obstructive sleep apnoea (1.41 (1.16–1.73)). Conclusion: Acute and subacute cough, as well as previous COVID-19 infection, were uncommon in this Finnish elderly population. The prevalence of chronic cough was higher than that previously found in younger adults. Chronic cough is a multifactorial disorder in the elderly. [ABSTRACT FROM AUTHOR]

Background: Upper airway cough syndrome (UACS) is generally considered a common cause of chronic cough but remains poorly recognised in Japan.Objective: This study aimed to assess whether UACS was a common cause of chronic cough in Japan, as is true in other countries. Interview and examination items were evaluated for their potential use in UACS diagnosis.Methods: All patients with chronic cough were preliminarily diagnosed with bronchial asthma, UACS, gastroesophageal reflux disease, or postinfectious prolonged cough, based on interviews and examinations. Treatment centred on nasal steroids was administered to the UACS group and standard treatment to the other groups. The observation period lasted 4 weeks. The subjective cough score at first diagnosis was set at 10, and the final diagnosis was made based on the treatment administered at the time the cough score had decreased to ≤2. The associations between the presence or absence of UACS and interview and examination items were statistically evaluated.Results: Among 230 patients with chronic cough, 146 were diagnosed with UACS-only. Multivariate logistic regression revealed that the assessment items 'awareness of mucus accumulating in the back of the throat', 'presence of abnormal echography findings', 'absence of associated coughing when exercising' and 'presence of coughing persisting after onset' were significantly correlated with the presence or absence of UACS (p < 0.05).Conclusions: UACS may be the most common cause of chronic cough in Japan and may be effectively treated with nasal corticosteroids. Diagnosing UACS might be possible by selecting appropriate interview and examination items. [ABSTRACT FROM AUTHOR]

Cough is a physiological defense mechanism regarded as having protective capabilities over lower airways, but it is also recognized as a symptom of various inflammatory respiratory disorders. Chronic cough affects 4-10% of adult patients and accounts for poor health-related quality of life. The most common cause of chronic cough is chronic bronchitis linked to active cigarette smoking. In non-smoking patients, it is induced by asthma, gastroesophageal reflux disease, and postnasal drip syndrome (PNDS) (observed in all types of rhinitis and rhinosinusitis). There is strong evidence based on epidemiological, histological, pathophysiological, and clinical findings suggesting an existing interconnection between the upper (URT) and the lower respiratory tract (LRT). In particular, the majority of asthmatic individuals are also diagnosed with allergic rhinitis (AR), and similarly, 40% of the subjects with allergic rhinitis have asthma. Furthermore, patients diagnosed with asthma and chronic obstructive pulmonary disease (COPD) are associated with an increased risk of developing chronic rhinosinusitis. Chronic cough can arise from all disorders affecting URT alone or with multiple other factors involved. In the cases when the chronic cough is associated with AR, non-allergic rhinitis (NAR), chronic rhinosinusitis (CRS) is referred to as upper airway cough syndrome (UACS). Initially, it was thought that postnasal drip syndrome is the most common cause of UACS however this was often disputed. Later, a different explicative mechanism presenting the fundament of UACS was adopted which includes PNDS, inflammation of the URT, and neurological hypersensitivity. A recognized challenge faced by clinicians is to identify a sharp distinction between cough syndrome elicited from URT and cough associated with LRT diseases. [ABSTRACT FROM AUTHOR]

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Purpose: Upper airway cough syndrome (UACS), described as chronic cough (CC) associated with allergic (AR), non-allergic rhinitis (NAR) or chronic rhinosinusitis (CRS), is one of the major causes of CC. We aimed to characterize a cohort of UACS patients with special attention to differences between patients with AR and NAR. Methods: A prospective analysis of clinical data of patients, diagnosed with UACS between 2015 and 2018. Results: There were 143 patients diagnosed with UACS, median age 52 years, women predominance (68.5%), The group comprised of 59 (41%) AR and 84 (59%) NAR subjects, CRS diagnosed in 17 (12%). Median cough duration: 48 months (IQR 24–120), median cough severity (VAS)—60 mm (IQR 42–78), median Leicester Cough Questionnaire (LCQ) score—11.3 (IQR 8.7–13.7), never-smokers: 70%. The most common symptoms: PND (62%), rhinorrhea (59%), nasal congestion (54%), abnormalities of sinus CT: septum deviation (62%), turbinates hypertrophy (53%), mucosal thickening (53%). UACS as the only cause of CC, was presented in 20 patients (14%). We found no differences between patients with AR and NAR in terms of age, gender, duration and severity of cough, BMI, blood eosinophil count, total IgE and FeNO. AR was associated with higher comorbidity of asthma than NAR (54% vs 35%, p = 0.019). Abnormalities in sinus CT scan were more frequently found in patients with NAR than AR (p = 0.018). Conclusion: NAR is the most common upper airway disease associated with UACS. Clinical characteristics of UACS patients with AR and NAR are similar with only minor differences between these groups. It seems reasonable to plan further studies concerning relationship of NAR and cough sensitivity, also in terms of potential similar neurogenic mechanism. [ABSTRACT FROM AUTHOR]

Cough is one of the most important defensive reflexes. However, extensive non- productive cough is a harmful mechanism leading to the damage of human airways. Cough is initiated by activation of vagal afferents in the airways. The site of their convergence is particularly the nucleus of the solitary tract (nTS). The secondorder neurons terminate in the pons, medulla and spinal cord and there is also the cortical and subcortical control of coughing. Upper airway cough syndrome (UACS) -- previously postnasal drip syndrome - is one of the most common causes of chronic cough together with asthma and gastroesophageal reflux. The main mechanisms leading to cough in patients with nasal and sinus diseases are postnasal drip, direct irritation of nasal mucosa, inflammation in the lower airways, upper airway inflammation and the cough reflex sensitization. The cough demonstrated by UACS patients is probably due to hypersensitivity of the upper airways sensory nerve or lower airways sensory nerve, or a combination of both. Further studies are needed to clarify this mechanism. [ABSTRACT FROM AUTHOR]

Copyright of Polish Otorhinolaryngological Review / Polski Przegląd Otorynolaryngologiczny (Index Copernicus) is the property of Index Copernicus International and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cause-directed treatment is the mainstay of the current diagnostic approaches for chronic cough. However, empiric therapy has also been advocated in several recent guidelines for the management of chronic cough in adults. This study was designed to evaluate the usefulness of empiric therapy for chronic cough in adults. A literature review is given to discuss the issues related to empiric therapy for chronic cough in adults, including the benefits and limitations of empiric therapy, empiric treatment for the common causes of chronic cough, and the selection of management strategies. Empiric therapy for chronic cough in adults, because of its simplicity and less expense, provides the convenience for doctors in the clinics with limited facilities. It can be used either alone or in combination. When used properly, it can avoid the excessive laboratory investigations and reach the therapeutic success rate similar to cause-directed treatment. Empiric therapy is a simple and useful means for the management of chronic cough in adults and can be used as a surrogate for cause-directed therapy. [ABSTRACT FROM AUTHOR]

Background: The causes of chronic cough in elderly patients have not been specifically investigated. Therefore, it remains to be determined whether chronic cough differs between elderly and non-elderly patients. Objectives: To investigate the distribution of causes of chronic cough in elderly patients in comparison with etiologies of chronic cough observed in non-elderly patients. Methods: From 2,989 new patients presenting consecutively to the Department of Respiratory Medicine of the Tongji Hospital over a 1.5-year period, 287 patients with chronic cough were enrolled in the study. Patients aged ≥60 years were assigned to the elderly group. The elderly group comprised 104 patients and the non-elderly group the remaining 183 patients. The causes of cough were primarily evaluated according to a modification of Irwin’s anatomic diagnostic protocol which included induced sputum cytology, verified by the specific therapy. Results: Cough-variant asthma (34.6 vs. 41.5%) and upper airway cough syndrome (19.3 vs. 23.5%) were the most common causes of chronic cough both in the elderly and non-elderly groups. The distribution of causes and frequency were significantly different between elderly and non-elderly groups: angiotensin-converting enzyme inhibitor (ACEI)-induced cough (16.3 vs. 1.7%, χ2 value = 22.12, p < 0.001) and gastroesophageal reflux disease (GERD; 10.6 vs. 3.7%, χ2 value = 5.14, p = 0.02) were more common in the elderly group. Conclusions: A more frequent incidence of ACEI-induced cough and GERD is the distinctive feature in the cause distribution between elderly and non-elderly patients with chronic cough. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article analyzes the most common causes of chronic cough. Researchers have found that upper airway cough syndrome (UACS) has been the most common cause of chronic cough due to a variety of rhinosinus conditions, asthma, and gastro-esophageal reflux disease (GERD). But there are certain other conditions that can cause chronic cough. The diagnostic methodology of chronic cough should focus on the detection and treatment of UACS, asthma, or GERD, singly or collectively. It has been believed that this approach will help in achieving cough resolution.

Prevalence of rhinitis and postnasal drip syndrome in patients attending hospital-based clinics with chronic cough were reported between 6% and 87%. American College of Chest Physicians guidelines recommend the term 'upper airway cough syndrome' (UACS) instead of 'postnasal drip' because symptoms of upper airway and cough overlap in patiets with chronic cough. Presence or absence of postnasal drip does not include or exclude UACS as a cause of cough. Hence, the first step empirical treatment should include UACS therapy in all patients with chronic cough. The initial treatment for chronic cough is combination of a first-generation antihistamine and an oral decongestant' or 'intranasal corticosteroids and intranasal antihistaminic agents'. Improvement in cough with this combination serves as a treatment and as a diagnostic test for the presence of UACS. If postnasal drip and cough persist despite treatment in the first month, the patient could be unrecognized rhinosinusitis, or nasal polyposis and should planned nasal endoscopy (rhinoscopy) and sinus BT. If this tests will be normal, UACS is not the cause of the chronic cough. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To evaluate characteristics of patients with chronic cough referred to otolaryngology, efficacy of common therapies, and the yield of common studies used to evaluate cause of chronic cough. Study Design: Retrospective review. Methods: Patients were identified as being referred for cough between 2005 and 2010. Initial consultation and clinical encounters were reviewed and diagnostic studies/therapies recorded. Findings on diagnostic studies were noted if they aided in treatment. Response to therapies was determined by reviewing clinical encounter documentation and therapies were rated: no response, partial response, or complete response. Results: 132 patients were included in the study. The average age was 57 years and 68% were women. 12% were currently on an ACE-inhibitor and 4% were actively using tobacco at time of presentation. 49% received treatment for upper airway cough syndrome (UACS) with minimal benefit. Yield of studies testing for UACS causes of cough were <10%. 55% of patients underwent PFT with methacholine challenge, with 15% diagnostic of asthma. 40% received a 14 day course of oral corticosteroids (OCS), with half noting complete response of cough. 70% received a course of proton pump inhibitor, with 25% noting improvement in cough. 20% underwent formal reflux evaluation, with 2% patients demonstrating occult reflux by DeMeester criteria. Other investigations for cause of cough were yield <25%. 46% completed a trial of benzonatate, with 57% noting improvement in cough. 32% underwent cough suppression therapy (CST) with three fourths of patients achieving improvement in cough. 24% underwent a trial of TCA therapy, with those who tolerated TCA therapy achieving 72% improvement in cough. Conclusions: Many patients were referred still actively smoking or on ACE-inhibitor therapy. Trial of OCS was an effective diagnostic test to differentiate steroid-responsive and steroid-unresponsive cough. Many patients who responded to OCS had normal pulmonary function tests. Upper airway cough syndrome and reflux disease were less prevalent than described in the literature. Tricyclic antidepressants, gabapentin, and pregabalin were useful for treating cough not otherwise attributable to UACS, asthma, or reflux. Benzonatate and cough suppression therapy were effective adjuvant treatments. [ABSTRACT FROM AUTHOR]