Management of chronic cough in highly demanded medical offices: efficacy of a sequential protocol

Introduction. Chronic cough is one of the main causes of medical consultati on. There is not however an homogeneous attitude regarding its management. A prospective evaluation was performed of a simple therapeutic protocol bas ed on the anatomical approach of the cough reflex. Methods. A total of 110 patients with chronic cough for longer than four we eks were studied. The exclusion criteria were: non-smoking during the last year, not to have diseases compromising the immune system and not to have r eceived inhibitors of the angiotensing converting enzyme. A three-visit ste pwise approach was performed with specific diagnostic tests ordered and a s pecific therapy instituted according to the clinical suspicion. Results. At the third visit, 97% of patients were free from cough or had im proved markedly. Cough causes were identified in 105 cases (95%) and the mo st common were: asthma (33%), postnasal dripping (29%), gastroesophageal re flux (10%), and asthma with associated gastroesophageal reflux (16%). Patie nts with asthma had a longer duration of tos compared with those who had po stnasal dripping (p < 0.05) as the only differential feature. Conclusions. The diagnostic-therapeutic diagram based on the anatomic refle x of cough is useful for the management of chronic cough in a highly demand ed medical office. With this protocol, the cause of cough can be identified and treated successfully in almost every patient with a small number of di agnostic tests and medical visits.