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Current literature reveals that up to 88% of individuals undergoing behavioral speech therapy (BST) for chronic refractory cough (CRC) demonstrate benefit at 4–8 weeks post-treatment. However, investigations of BST are confounded by overlapping use of neuromodulators, missing follow-up data, and an absence of long-term outcomes. This study investigated treatment outcomes beyond 6 months in individuals diagnosed with CRC, and whose treatment outcomes were clinically undocumented. Participants with CRC 6 months or greater beyond treatment completion were recruited. Participants completed a post-treatment Leicester Cough Questionnaire (LCQ) and a telephone interview. Demographic data, cough characteristics, treatment adherence, BST outcomes, and pre- and post-treatment LCQ scores were evaluated. 80 individuals met inclusion criteria and 29 consented to participate. Of these, 27 were recommended BST. The majority were female (19/27) with average age of 58 years (SD = 12). Mean cough duration was 60 months (SD = 98) and mean post-BST duration was 20 months (SD = 9). A significant increase in pre- to post-treatment LCQ scores occurred [4.4 (SD = 4.2)] (p

Human respiratory events, such as coughing and sneezing, play an important role in the host-to-host airborne transmission of diseases. Thus, there has been a substantial effort in understanding these processes: various analytical or numerical models have been developed to describe them, but their validity has not been fully assessed due to the difficulty of a direct comparison with real human exhalations. In this study, we report a unique comparison between datasets that have both detailed measurements of a real human cough using spirometer and particle tracking velocimetry, and direct numerical simulation at similar conditions. By examining the experimental data, we find that the injection velocity at the mouth is not uni-directional. Instead, the droplets are injected into various directions, with their trajectories forming a cone shape in space. Furthermore, we find that the period of droplet emissions is much shorter than that of the cough: experimental results indicate that the droplets with an initial diameter ≳ 10 μ m are emitted within the first 0.05 s, whereas the cough duration is closer to 1 s. These two features (the spread in the direction of injection velocity and the short duration of droplet emission) are incorporated into our direct numerical simulation, leading to an improved agreement with the experimental measurements. Thus, to have accurate representations of human expulsions in respiratory models, it is imperative to include parametrisation of these two features.

BACKGROUND: It is very difficult to observe tuberculosis (TB) transmission chains and thus, identify superspreaders. We investigate cough duration as a proxy measure of transmission to assess the presence of potential TB superspreaders.DESIGN: We analyzed six studies from China, Peru, The Gambia and Uganda, and determined the distribution of cough duration and compared it with several theoretical distributions. To determine factors associated with cough duration, we used linear regression and boosted regression trees to examine the predictive power of patient, clinical and environmental characteristics.RESULTS: We found within-study heterogeneity in cough duration and strong similarities across studies. Approximately 20% of patients contributed 50% of total cough days, and around 50% of patients contributed 80% of total cough days. The cough duration distribution suggested an initially increasing, and subsequently, decreasing hazard of diagnosis. While some of the exposure variables showed statistically significant associations with cough duration, none of them had a strong effect. Multivariate analyses of different model types did not produce a model that had good predictive power.CONCLUSION: We found consistent evidence for the presence of supercoughers, but no characteristics predictive of such individuals.

Background Chronic wet cough, the most common symptom of a disease spectrum that encompasses protracted bacterial bronchitis (PBB) and bronchiectasis, is common among Aboriginal children. In the absence of any community prevalence data, and with the high burden of respiratory disease and the European Respiratory Society task force's recommendation to identify disease burden, we determined the prevalence of chronic wet cough and PBB in young Aboriginal children in four remote communities in north Western Australia. Methods A whole-population, prospective study was conducted. Aboriginal children aged ≤7 years were clinically assessed for chronic wet cough by paediatric respiratory clinicians between July 2018 and May 2019. Where children had a wet cough but parents reported a short or uncertain cough duration, children were followed up 1 month later. A medical record audit 6 weeks to 3 months later was used to determine those children with chronic wet cough who had PBB (based on response to antibiotics). Results Of the 203 children, 191 (94%; median age 3.5 years, range 0–7 years) were enrolled. At the initial visit, chronic wet cough was present in 21 (11%), absent in 143 (75%) and unknown in 27 (14%). By follow-up, the total prevalence of chronic wet cough was 13% (95% CI 8–19%) and 10% (95% CI 7–17%) for PBB. Chronic wet cough was more common in the two communities with unsealed roads (19%) compared to the two with sealed roads (7%). Conclusion Given the relatively high prevalence, strategies to address reasons for and treatment of chronic wet cough and PBB in young Aboriginal children in remote north Western Australia are required., Prevalence of chronic wet cough and protracted bacterial bronchitis in Aboriginal children in remote, north Western Australia is high. There is a need to implement strategies to detect and manage these entities and measure prevalence in other settings. http://bit.ly/33QLzDA

The transport and fate of human expiratory droplets play a key role in the transmission of respiratory infectious diseases. In this paper, we present a modeling approach to understand the fundamental dynamics of exhaled droplets in human respiratory activities. The model solves a series of governing equations of droplets and uses a continuous random walk model to simulate turbulent fluctuations in violent expiratory events. The validation of the model shows the improvement in the prediction of dispersion of median-sized droplets. We show that these droplets are sensitive to environmental conditions, including temperature, humidity, and ambient flows. Applying the model to a set of idealized conditions such as free-fall and continuous jets, we demonstrate significantly different impacts of environmental parameters on droplets with different sizes. Using a realistic droplet size distribution and cough duration, we quantify the transport and fate of droplets in the near field of source and the potential influences by ambient conditions. The model we developed from this study could be applied to study the mechanisms for airborne pathogens, e.g., influenza virus and new coronavirus.

Background Despite close link exists between cough severity and quality of life (QoL), whether gender difference is implied in the effect of cough on QoL has not been studied yet. This study primarily aims to investigate whether the association between cough severity and QoL is modified by gender in patients with postinfectious cough. Methods Secondary analyses were performed in 180 participants with postinfectious cough in a multisite randomized controlled trial. Baseline demographics, clinical characteristics and score of cough specific quality of life questionnaire (CQLQ) were collected. Linear regression analyses were conducted to examine gender difference in CQLQ score and the association between cough severity and CQLQ score. Results Difference between women and men was not significant in CQLQ total score in the unadjusted analysis (P = 0.077). Women had a 2.20-point higher CQLQ total score than men (95% confidence interval (CI) 0.11–4.30; P = 0.039), after adjusting for age, cough duration, cough severity, and clinical center. Gender significantly modified the association between cough severity and CQLQ total score (coefficient 1.80, 95% CI 0.29–3.30; P = 0.020), after adjusting for age, cough duration, and study center. An increase of 1-point in cough severity was associated with a 2.55-point (95% CI 1.16–3.95) increase in CQLQ total score in women versus a 1.26-point (95% CI 0.20–2.31) increase in men (P = 0.020). Conclusions Female sex may be associated with worse QoL than men, and women’s QoL may be more significantly impaired as cough symptom deteriorates. Gender difference should be taken into account in the clinical settings and research of cough and cough related QoL. Trial registration: Chinese Clinical Trial Registry, ChiCTRTRC12002297. Registered 19 June 2012, http://www.chictr.org.cn/abouten.aspx.

Cough is one of the most common causes of seeking the primary medical care, especially during the autumn and the spring. This article is a review of literature aimed at differential diagnosis of possible causes of acute cough in children and adults. Given a vast majority of diseases associated with cough, differential diagnosis have to consider several issues. The key issue is cough duration and possible anatomical location of the pathological changes. An algorithm of differential diagnosis of acute cough in children and adults and description of most common diseases associated with acute cough are given in the review. Further diagnostic work-up should be driven by the duration of cough as soon as the acute cough could be first manifestation of a chronic disease.

Objectives Our therapeutic approach to a habit/tic cough is simple reassurance in a single consultation. To quality assure our practice, we followed up children to determine outcomes at least 3 months after diagnosis. Design Consecutive children diagnosed over 6 years were studied. Medical records were analyzed retrospectively and parents answered a scripted verbal survey. Results Fifty-five patients were diagnosed (median age 9.9 years), with a median cough duration of 3 months (IQR 2-7.5 months, range up to 3 years). In 51/55 (93%) cases, cough was absent during sleep. 51/55 (93%) received prior medications with median 3 therapeutic trials, none of which resolved the cough. Follow-up was possible in 39/55 (71%) children after a median duration of 1.9 years. In 32/39 (82%), the cough had resolved completely (59% within 4 weeks, including 12% on the day), and it improved in 6/39 (15%). In the 26/39 (67%) parents who said they believed the diagnosis, there was 96% resolution of the cough, versus the 13/39 (33%) who were sceptical or disbelieving, when there was only 54% resolution. 7/39 (18%) children were later diagnosed with a tic disorder, functional symptoms, or a behavioural/psychiatric disorder. Conclusions Habit cough can be diagnosed from the characteristic history; the crucial question is whether the cough disappears during sleep. We have shown successful long term outcomes following a single consultation with simple reassurance, but it is important that the child and parents believe the explanation. It is not uncommon for subsequent tic disorders or behavioral issues to emerge.

The sudden outbreak of coronavirus (COVID-19) has infected over 100 million people and led to over two million deaths (data in January 2021), posing a significant threat to global human health. As a potential carrier of the novel coronavirus, the exhaled airflow of infected individuals through coughs is significant in virus transmission. The research of detailed airflow characteristics and velocity distributions is insufficient because most previous studies utilize particle image velocimetry (PIV) with low frequency. This study measured the airflow velocity of human coughs in a chamber using PIV with high frequency (interval: 1/2986 s) to provide a detailed validation database for droplet propagation CFD simulation. Sixty cough cases for ten young healthy nonsmoking volunteers (five males and five females) were analyzed. Ensemble-average operations were conducted to eliminate individual variations. Vertical and horizontal velocity distributions were measured around the mouth area. Overall cough characteristics such as cough duration time (CDT), peak velocity time (PVT), maximum velocities, and cough spread angle were obtained. The CDT of the cough airflow was 520–560 m s, while PVT was 20 m s. The male/female averaged maximum velocities were 15.2/13.1 m/s. The average vertical/horizontal cough spread angle was 15.3°/13.3° for males and 15.6°/14.2° for females. In addition, the spatial and temporal distributions of ensemble-averaged velocity profiles were obtained in the vertical and horizontal directions. The experimental data can provide a detailed validation database the basis for further study on the influence of cough airflow on virus transmission using computational fluid dynamic simulations.

Background: Protracted bacterial bronchitis (PBB) is characterised by chronic wet cough and if left untreated can lead to chronic suppurative lung disease (CSLD). Aboriginal children suffer a disproportionate burden of CSLD. Chronic wet cough is the earliest symptom of CSLD, yet there is no prevalence community data in any setting. The ERS statement on PBB recommended collection of prospective data to identify disease burden and understand its natural history. Aim: To determine prevalence of chronic wet cough and PBB in young Aboriginal children. Methods: A whole population, prospective study. Aboriginal children, 0-7 years were assessed for chronic wet cough by paediatric respiratory clinicians at 2 time points over a 1-month period from July 2018-April 2019 in 4 remote communities in northern Western Australia. Families were first given culturally appropriate lung health information about chronic wet cough. Clinical assessment and parent report of cough character and duration were recorded. Children were followed up one month later where parents were unsure about cough duration or reported short duration. A medical record audit 6-weeks later determined those children with chronic wet cough who had PBB (based on response to antibiotics). Results: 191/203 children (mean age 3.5y, SD 2) were enrolled. 28 were not seen at visit-2, 21/191 (11.0%) had chronic wet cough (mean age 2.9y, SD 2.2) with at least 71.4% having PBB. Discussion: This first ever community study on chronic wet cough and PBB showed that these conditions are prevalent in northern Western Australian communities. Longitudinal follow up and culture appropriate health interventions are required to reduce the burden of future lung disease.

Objectives: We evaluated the impact of refractory or unexplained chronic cough (RCC/UCC) frequency on health-related quality of life (HRQoL). Methods: A Phase 2b, 12-week, double-blind RCT included RCC/UCC subjects (cough duration ≥1 year; baseline VAS ≥40 mm) (NCT02612610). Treatment groups (placebo, gefapixant 7.5mg, 20mg, and 50mg) were pooled for this analysis. A sound-recording device (VitaloJAKTM, Vitalograph, Ltd.) was used to assess Awake Cough Frequency (aCF). The Leicester Cough Questionnaire (LCQ; Total, Physical, Psychological and Social scores) assessed HRQoL. Mean baseline LCQ scores across tertiles of aCF (0-33 [lowest], 34-66, and 67-100th percentiles) and baseline to Week 4 changes across aCF responder groups (≥30% reduction vs 1.5, >0.5, and >0.6 on the Total, Physical, Psychological/Social domains are considered meaningful. Results: LCQ and aCF were completed by 251 subjects. At baseline, mean (SE) Total LCQ scores were highest (better) for the lowest tertile of aCF: 13.1 (0.31), 11.2 (0.31), and 10.7 (0.31) for the 0-33, 34-66, and 67-100 percentiles, respectively. A similar trend was observed for the baseline LCQ domain scores. After 4 weeks of treatment, aCF responders had an LS mean (SE) LCQ Total score increase of 4.2 (0.25) while non-responders had an increase of 1.2 (0.28) (p Conclusion: RCC/UCC subjects with higher aCF report worse HRQoL. Clinically meaningful improvements in aCF result in improvements in HRQoL that are consistent with LCQ meaningful change thresholds.

BackgroundThe current practice in Ethiopia to diagnose tuberculosis is screening patients with cough for at least two weeks. A health facility based study was conducted to estimate the prevalence of smear and culture positive pulmonary TB among patients presenting with cough ≥2 weeks and MethodsA cross-sectional study design was used to recruit patients with cough of any duration from four selected health centers in Addis Ababa, between August and December 2016. Sputum samples were collected from patients reporting productive cough of any duration and screened for Pulmonary Tuberculosis (PTB) using smear microscopy and culture methods. Mycobacterium tuberculosis isolates obtained from culture positive samples were characterized using RD9 deletion typing.ResultsMajority (39.7%) of the 725 study participants was in the age range of 20-30 years, and 5.0% were smear positive using smear microscopy. The prevalence of smear positive PTB among patients presented with cough duration of ≥2 weeks was significantly higher compared to those patients presented with cough duration of Mtb; 19(46.3%) from those who had cough duration of ConclusionScreening of PTB using smear microscopy alone and cough duration of at least two weeks would negatively affect early diagnosis and treatment initiation in a considerable number of PTB patients who reports cough duration of

Background: While gastroesophageal reflux disease (GERD) is one of the commonest causes of subacute/chronic cough along with cough-variant asthma (CVA) and rhinosinusitis, its clinical impact remains unknown. Therefore, we sought to investigate the impact of GERD in patients with subacute/chronic cough. Methods: Between April 2012 and March 2018, a total of 312 patients presenting subacute or chronic cough lasting for ≥3 weeks [median cough duration, 4.9 (0.7–434) months] underwent diagnostic tests. GERD symptoms and cough-specific QoL were evaluated through the Frequency Scale for Symptoms of Gastroesophageal reflux (FSSG) and the Japanese version of the Leicester Cough Questionnaire (J-LCQ). According to the FSSG domains, patients with GERD were arbitrarily categorized into 3 groups; acid-reflux predominant, dysmotility predominant, and pauci-symptoms groups, respectively. Results: The average scores of J-LCQ was 12.5 (SD3.7). One hundred-forty three were diagnosed as having GERD-related cough based on classical reflux symptoms including heartburn and characteristic triggers of cough such as phonation, rinsing, lying, and eating. Most of them (89.8%) had other causative diseases including CVA. Cough lasted longer (p = 0.019) and required a longer time until alleviation (p = 0.003) in patients with GERD than in those without GERD. They also scored lower J-LCQ than counterpart group (p

Background The Leicester Cough Questionnaire (LCQ) is one of the few specific quality-of-life questionnaires (QOLQ) dedicated to measuring the impact of chronic cough on patients' health/condition. Objectives The aim of the study was to validate the Polish version of the LCQ. Material and methods The LCQ was translated forward and backward. The Polish version of the LCQ was tested on 35 patients suffering from chronic cough (23 women, median age 60 years, nonor ex-smokers, median cough duration of 23 weeks). Its validity was tested by comparison to a visual analogue scale (VAS) of cough intensity and other health questionnaires (hospital anxiety and depression scale - HADS, Euro-Quality of Life Questionnaire - EQ5D, St. George's Respiratory Questionnaire - SGRQ). The internal reliability of the Polish version of the LCQ was determined using the Cronbach alpha coefficient and its repeatability by the intraclass consistency coefficient. Results The translation of the LCQ into Polish was accepted by the author of the original LCQ. The Cronbach's alpha coefficient for total LCQ was 0.89, and reached 0.82, 0.86 and 0.78 for the physical, psychological and social domain, respectively. There were significant negative correlations between cough severity measured by VAS, the results of the EQ5D and SGRQ and the Polish version of the LCQ. The intraclass correlation coefficient of the test-retest reliability was significant (0.99). Conclusions The Polish version of the LCQ has been validated and is a reliable tool to measure the impact of chronic cough on quality of life of patients with chronic cough.

Impressive reductions in pertussis have been achieved in the U.S. during the 20th century through childhood vaccination. Over the past two decades, increasing pertussis incidence has highlighted the need for accurate and timely reporting of cases to improve prevention and control efforts. We assessed components of the pertussis case definition, comparing use of clinical characteristics and laboratory results and their effects on internal validity, including an examination of the 2014 infant case definition. All reported pertussis cases in Michigan during 2000–2010 with data on cough length (N = 3310) were analyzed using multivariate statistics to internally validate reported cases, and calculate odds of meeting the clinical case definition, including a cough of at least 14 days. Cough duration of reported cases averaged 32 days and was longer with greater time interval between cough onset and initial presentation to a physician. Only about half of reported cases had positive laboratory results. Among cases seeking medical evaluation prior to meeting the cough duration required to fulfill the clinical case definition, the presence of positive lab results doubled the odds that the cough duration was not met compared to cases without a positive lab test. Clinical characteristics of pertussis are frequently ignored in applying the case classification. Relying solely on laboratory confirmation and disregarding clinical characteristics results in undiagnosed pertussis cases among those who are vaccinated, among adults, and among anyone who delays seeking care. This may prevent use of appropriate prevention and prophylaxis in contacts., Highlights • Increasing incidence of pertussis in the U.S. makes accurate diagnosis and reporting of cases essential to control efforts. • Many pertussis cases with positive laboratory tests sought medical evaluation prior to meeting the cough duration criterion. • Clinical characteristics of pertussis are frequently ignored by public health and medical professionals in classifying cases. • Laboratory confirmation without accompanying clinical characteristics may result in mis-diagnosis of pertussis.

Introduction: Chronic cough is a challenging problem as available medications lack proven efficacy. AF-219, a P2X3 antagonist, effectively reduced cough frequency in 2 previous phase 2 trials at doses 50-600mg BID1. The present study explored the dose response relationship below 50mg BID. Methods: A randomized, double-blind, placebo-controlled, crossover, dose escalation study of AF-219 recruited patients with chronic cough ≥1 year and cough severity VAS≥40mm. Patients received 16 days of AF-219 or placebo, dose escalated every 4 days (7.5mg, 15mg, 30mg, 50mg BID consecutively); after ≥15days washout patients crossed over. Awake cough frequency was measured with an ambulatory cough monitor (VitaloJak). Results: 30 patients (12 naive, 18 previously treated at higher doses) at 10 US sites were randomized; mean age 60yrs, median cough duration 13yrs, 80% female. AF-219 30 and 50mg BID produced equivalent, marked reductions in awake cough vs. placebo (p 0.05). Patient perception of improvements in cough severity lagged the objective measure. Separation between efficacy and tolerability was seen, with few patients reporting taste AEs at 7.5 and 15mg (none in naive group). Conclusion: Lower doses of AF-219 produced marked reductions in cough frequency; fewer patients noted reduced taste, portending promising efficacy and tolerability in studies of longer duration. 1Lancet 2015;385:1198.

Summary Background: Cough is symptomatic of a broad range of acute and chronic pediatric respiratory illnesses. No studies in children have tested for an extended panel of upper airway respiratory viruses and bacteria to identify whether they predict cough outcomes, irrespective of clinical diagnosis at the time of acute respiratory illness (ARI). We therefore determined whether upper airway microbes independently predicted hospitalization and persistent cough 28‐days later in children presenting with an ARI, including cough as a symptom. Methods: A cohort study of children aged

The present study examined the acoustic features of cough across sex and age; and its relationship to the perception of voice production. A total of 30 cough samples and 30 voice samples were collected from 15 healthy females and 15 healthy males, ranging from 17 to 79 years. Coughs containing three distinct phases were submitted to an acoustic analysis of the long-term average spectrum (LTAS) and cough duration. Both cough and voice samples were examined perceptually by a group of 20 speech-lan

BACKGROUND The surveillance case definition for confirmed pertussis requires that an individual with a positive polymerase chain reaction (PCR) result for Bordetella pertussis have 2 weeks or more of cough and at least one of the following: paroxysmal coughing, inspiratory "whoop," or posttussive vomiting. OBJECTIVES Determine (1) proportion of individuals with a positive PCR result who met additional criteria for surveillance confirmed pertussis, (2) whether the likelihood of PCR-positive individuals meeting additional elements of surveillance case definition varied by age or vaccination status, and (3) whether elements of the current case definition influence the likelihood of pertussis confirmation in PCR-positive individuals. METHODS Pertussis PCR results were compared with case investigation data. RESULTS Eighty-eight percent (165/188) of PCR-positive individuals met requirements for confirmed pertussis. Sixty-one percent (14/23) of PCR-positive individuals who had less than 2 weeks but more than 1 week of cough had at least one other reported sign or symptom. Fourteen (100%) reported paroxysmal coughing, 7 (50%) "whoop," and 7 (50%) posttussive vomiting. Infants who met case definition were more likely to have reported apnea than were older individuals (15/17 vs 45/86, OR = 6.8, 95% CI = 1.4-64.2). CONCLUSIONS Decreasing cough duration from 2 weeks or more to more than 1 week would result in 95 percent of those with positive PCR results meeting confirmation criteria for pertussis. Apnea should be considered an additional sign for pertussis confirmation in infants.

Objective To explore drugstore personnel's knowledge and practice on management of a suspected case of tuberculosis (TB). Method Seventy randomly selected drugstores in Songkhla province of Southern Thailand were visited by simulated clients (SCs) who asked for medication for relieving a one-month cough with fever. All questions asked by the drugstore personnel, advice given and drugs dispensed were noted and analysed. The drugstores were subsequently visited and the managers were interviewed. Key findings For the SC study, 55 out of 70 (79%) drugstore personnel took a history before dispensing drugs, but only 14 (20%) asked about cough duration. Only four drugstore personnel identified TB as a possible diagnosis for a case with one-month cough and fever, and only three recommended the SC to see a doctor. From the interviews, 46 (66%) perceived the probability of encountering TB at their workplace to be low. The knowledge on symptoms of suspected TB was poor. Sixty-eight (97%) would suspect TB if and only if the client with prolonged cough also had tiredness, weight loss, difficulty breathing or haemoptysis. In contrast to their practice with the SC, 46 (66%) claimed that they would recommend a client with one-month cough and fever to see a doctor. Conclusions The majority of drugstore personnel failed to detect suspected TB cases and did not give a proper referral. Interventions to educate drugstore personnel to recognise symptoms of suspected TB and to become aware in TB epidemics in this setting are urgently needed.

This study examined the relationships between subjective descriptors and objective airflow measures of cough. We hypothesized that coughs with specific airflow characteristics would share common subjective perceptual descriptions. Thirty clinicians (speech-language pathologists, otolaryngologists, and neurologists) perceptually evaluated ten cough audio samples with specific airflow characteristics determined by peak expiratory flow rate, cough expired volume, cough duration, and number of coughs in the cough epoch. Participants rated coughs by strength, duration, quality, quantity, and overall potential effectiveness for airway protection. Perception of cough strength and effectiveness was determined by the combination of presence of pre-expulsive compression phase, short peak expiratory airflow rate rise time, high peak expiratory flow rates, and high cough volume acceleration. Perception of cough abnormality was defined predominantly by descriptors of breathiness and strain. Breathiness was characteristic for coughs with either absent compression phases and relatively high expiratory airflow rates or coughs with significantly low expired volumes and reduced peak flow rates. In contrast, excessive strain was associated with prolonged compression phases and low expiratory airflow rates or the absence of compression phase with high peak expiratory rates. The study participants reached greatest agreement in distinguishing between single and multiple coughs. Their assessment of cough strength and effectiveness was less consistent. Finally, the least agreement was shown in determining the quality categories. Modifications of cough airflow can influence perceptual cough evaluation outcomes. However, the inconsistency of cough ratings among our participants suggests that a uniform cough rating system is required.

A prospective cross sectional study was conducted in the Department of Medicine, Christian Medical College and Hospital and Civil Hospital, Ludhiana. Patients between the age group 18-70 years were included in the study. 790 patients were taken for the study. Numbers of males were 65.4% and females 34.6%. In the study, it was found that in patients with 2 weeks cough duration, sputum AFB was positive at 2 weeks as well as 3 weeks. But in those patients who were negative at 2 weeks duration, when they were re-examined at 3rd week, the positivity of sputum AFB had increased which was statistically significant. So sputum analysis at 3 weeks is better than 2 weeks for tuberculosis evaluation, although evaluation of sputum should be done early at 2 weeks, cough duration for early diagnosis and treatment initiation.

BACKGROUND: Women are consistently over-represented in specialist cough clinics and known to have a more sensitive cough reflex than men. Whether female sex and other patient characteristics are associated with higher cough rates is not known. A study was conducted to determine the predictors of objective cough frequency in patients presenting to a tertiary referral clinic with chronic cough. METHODS: 100 subjects (65 women) of mean (SD) age 55.8 (11.0) years and median cough duration 4 years (IQR 2.0-10.0) with unexplained chronic cough completed flow-volume loops (mean (SD) forced expiratory volume in 1 s 103 (15.2)% predicted; forced expiratory flow (FEF(50)) 68.8 (24.1)% predicted), methacholine challenge (42% positive), citric acid cough reflex sensitivity (C5; 0.12 M (IQR 0.06-0.50)) and the Leicester Cough Questionnaire. 24-h ambulatory cough monitoring was performed in 86 subjects; manually counted coughs were quantified as the number of explosive cough sounds per hour. RESULTS: Women coughed significantly more than men (geometric mean 16.6 coughs/h (95% CI 13.1 to 21.0) vs 9.4 coughs/h (95% CI 6.4 to 13.9), p = 0.01)). The cough reflex was also more sensitive in women than in men (median logC5 -0.9 M vs -0.6 M, p = 0.002), but cough-related quality of life was similar in women and men (12.0 (3.6) and 12.2 (3.2), respectively, p = 0.76). Linear regression analysis showed that 38.6% of the variation in cough rate was predicted by sex (p = 0.01), logC5 (p

Research Question : Can we minimize cough duration and number of sputum samples in chest symptomatic patients for screening of TB? Objective : To evaluate cough of 3 weeks versus 2 weeks duration using two sputum samples versus three samples in chest symptomatic patients attending the OPD. Study Design : Hospital-based cross-sectional study. Materials and Methods : Outpatients (2810) with H/O cough of 3 weeks and 2 weeks duration were screened by subjecting them to sputum microscopy for tuberculosis using two sputum samples as well as three samples following standard procedure for sputum collection, staining and acid-fast bacillus (AFB) identification. Those on drugs were not included. Results : Using .2 weeks cough, sputum positivity rate was 12%, nearly as high as the sputum positivity among patients with .3 weeks cough, i.e. 14%. First sputum smear alone on an average could detect 91.8% cases, while the first two sputum smears could detect on an average 96% cases. The study showed that maximum number of cases was diagnosed by only two sputum smears and added diagnostic value of third specimen was small, i.e. 4%.High sputum positivity rate using .2 weeks cough with two sputum samples was seen. Conclusion : The sensitivity analysis of the study showed that using .2 weeks cough with two sputum samples gives almost similar values as .3 weeks cough with three sputum samples, but this needs further confirmatory results of culture sensitivity. Hence, using .2 weeks cough with two sputum samples as the diagnostic criteria for screening of cough patients for TB should be recommended as one way of improving efficient use of scarce resources.

McGarvey et al 1 suggest that full investigation of patients with persistent cough improves treatment. I reviewed 100 such patients seen consecutively. All had normal chest radiographs, two were current smokers, and their mean cough duration was 18.8 months (range one month to 20 years). Initial treatment was given on the basis of history and routine clinical examination with investigations reserved for patients not responding after one month. Thirty four patients failed to return after their initial appointment. Twenty were contacted and all reported complete resolution of their symptoms. Clinical diagnoses in the 14 others were similar and they probably defaulted because of improvement, but have been excluded from analysis. Investigations performed included radiology of the sinuses in 8%, bronchial provocation testing …