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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Peritoneal dialysis (PD) and hemodialysis (HD) are both common forms of dialysis for patients with end-stage renal disease. A few case reports have suggested that cough is associated with PD. From 1991 to 1998, 17 patients being treated with PD at the Toronto Western Hospital demonstrated persistent cough severe enough for referral to a respirologist. Causes of cough, often more than one cause per patient, included asthma, post-nasal drip, gastroesophageal reflux disease (GERD), chronic obstructive pulmonary disease, congestive heart failure, allergic rhinitis, pleural effusion, and respiratory infection. The aim of this cross-sectional study was to establish the prevalence of cough among PD patients, to determine if PD patients more commonly have a dry persistent cough than do HD patients, and, if the latter case is true, the possible reasons for it. A detailed survey of 92 PD patients and 91 HD patients was conducted in 1998 and 1999 at the University Health Network. Survey questions inquired about patient respiratory symptoms since onset of dialysis. Charts were reviewed to obtain information on use of medications possibly relevant to cough. In the PD and HD groups, 52% and 23% were females (p = 0.001), and the mean ages were 59.1 and 60.1 years, respectively. Angiotensin converting enzyme (ACE) inhibitors had been taken by 65% (PD) and 55% (HD) of patients, and beta-blocking medications by 43% (PD) and 51% (HD). Since initiation of dialysis--mean 2.7 years (PD) and 3.7 years (HD)--22% of PD patients reported persistent cough versus 7% of HD patients (p = 0.003). Although no significant association was seen between cough and self-reported heartburn in HD patients (p = 0.439), a significant association between cough and self-reported heartburn was seen in PD patients: 67% of PD patients with persistent cough reported heartburn versus 29% of those without cough (p = 0.008). The findings suggest that GERD and associated cough are more common in PD patients than in HD patients, perhaps owing to increases in intra-abdominal pressure from the peritoneal dialysate.
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PMID:Prevalence and causes of cough in chronic dialysis patients: a comparison between hemodialysis and peritoneal dialysis patients. 1104 77

Allergic rhinitis (AR) is rarely found in isolation and needs to be considered in the context of systemic allergic disease associated with numerous comorbid disorders, including asthma, chronic middle ear effusions, sinusitis, lymphoid hypertrophy with obstructive sleep apnea, disordered sleep, and consequent behavioral and educational effects. The coexistence of AR and asthma is complex. First, the diagnosis of asthma may be confounded by symptoms of cough caused by rhinitis and postnasal drip. This may lead to either inaccurate diagnosis of asthma or inappropriate assessment of asthma severity with over treatment of the patient. The term "cough variant rhinitis" is therefore proposed to describe rhinitis that manifests itself primarily as cough that results from postnasal drip. AR, however, also has a causal role in asthma; it appears both to be responsible for exacerbating asthma and to have a role in its pathogenesis. Postnasal drip with nasopharyngeal inflammation leads to a number of other conditions. Thus sinusitis is a frequent extension of rhinitis and is one of the most frequently missed diagnoses in children. Allergen exposure in the nasopharynx with release of histamine and other mediators can cause Eustachian tube obstruction possibly leading to middle ear effusions. Chronic allergic inflammation of the upper airway causes lymphoid hypertrophy with prominence of adenoidal and tonsillar tissue. This may be associated with poor appetite, poor growth, and obstructive sleep apnea. AR is therefore part of a spectrum of allergic disorders that can profoundly affect the well being and quality of life of a child. Prospective cohort studies are required to assess the disease burden caused by AR in childhood and to further assess the potential educational impairment that may result. Because AR is part of a systemic disease process, its management requires a coordinated approach rather than a fragmented, organ-based approach.
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PMID:Pediatric allergic rhinitis and comorbid disorders. 1144 1

Gastroesophageal reflux (GER) is one of the three most common causes of chronic cough in children, along with postnasal drip syndrome and asthma. There may be no gastrointestinal symptoms up to 50-75% of the time. GER plays a causative role in chronic cough, asthma without allergy and posterior laryngitis. GER most commonly provokes coughing by stimulating an esophageal-bronchial reflex and by irritating the lower respiratory tract by microaspiration. Twenty-four-hour pH monitoring of the distal esophagus is the most accurate diagnostic method for children with suspected GER and it helps to establish a temporal correlation between cough and GER. The first step of the treatment is the association of postural and dietetic measures and medications (prokinetics and antacids). The length of the treatment is a minimum of 3 months up to the age of walking. Surgical treatment must be reserved for the failure of medical treatment. The benefits of minimally invasive surgery are evident in children with chronic cough, who have a faster recovery with fewer complication than after open surgery.
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PMID:[Chronic cough and gastroesophageal reflux in children]. 1168 86

Psychogenic cough, also known as "habit cough," is a well-documented condition in the pediatric and adolescent population, with numerous cases reported in the medical literature. Many of these patients are strikingly similar in their clinical characteristics and, although the data are limited, a variety of treatment options may be successful in terminating this form of cough. However, psychogenic cough in adults has been reported infrequently and is less well defined. We report two cases of psychogenic cough in adult patients referred to our service for an evaluation of refractory, chronic cough and review the relevant medical literature. Our patients seemingly represent the first cases of psychogenic cough reported in the geriatric population and share clinical features with children, adolescents, and young adults. One case is unique in the sense that the cough responded to a distracter in the form of a throat lozenge, and this patient consumed > or = 20 lozenges/day for approximately 13 years. Psychogenic cough should be considered in adult patients who present with a chronic cough of no obvious organic basis that has failed therapy directed at postnasal drip, asthma, and gastroesophageal reflux. We propose criteria to assist in making a diagnosis of psychogenic cough in adult patients and review the limited information that exists concerning treatment modalities.
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PMID:Psychogenic cough in adults: a report of two cases and review of the literature. 1189 31

In addition to heartburn and regurgitation, cough is a frequent nonspecific complaint of patients with gastroesophageal reflux disease. The incidence of alternative etiologies for patients with chronic cough who are undergoing antireflux surgery is not known. To determine this, and the response of chronic cough to fundoplication, we performed a retrospective review of 129 patients with proven gastroesophageal reflux referred for surgical therapy. Chronic cough was present in 37 (29%) preoperatively. No differences were found in age, sex, or preoperative manometric findings between those with and without chronic cough. Patients with cough had a higher number of lower esophageal reflux events on preoperative 24-hour pH testing, and were more likely to have persistent dysphagia after surgery. Fifty-nine percent of patients with cough had an alternative etiology for cough, compared to 36% of those without cough. Of the common alternative etiologies, only a history of postnasal drip occurred more frequently in those with cough. Complete resolution of cough occurred in 24 patients (64%), with another 10 (27%) reporting significant improvement. The average cough score improved significantly regardless of which coexisting etiology the patients may have had. Additionally, heartburn and regurgitation were improved in 94% of all patients.
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PMID:Laparoscopic antireflux surgery and its effect on cough in patients with gastroesophageal reflux disease. 1198 13

A wide range of disease processes may present with cough and definitive treatment depends on making an accurate diagnosis of the cause. Acute or short-lived cough, which most commonly occurs in association with viral upper respiratory tract infection, is of a little consequence, usually resolving in a matter of days. The most common chronic causes of cough are post-nasal drip, asthma, gastro-esophageal reflux and chronic bronchitis. The different conditions that cause cough have in common the fact that are mediated by the vagus nerves, with sensory receptors in and under the epithelium from the larynx to the smaller bronchii. The receptors are polymodal, responding to a large variety of stimuli, including mechanical and chemical irritants, inflammatory mediators, intraluminal material and large volume changes of the lung. Intensive treatment of underlying cause usually leads to improvement or resolution of cough. However, in a minority of patients, no underlying cause is identified despite appropriate investigation: in these subjects or when cough interferes with patient's health or sleep is indicated a non specific treatment with antitussive therapy.
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PMID:[Coughing. Pathognomic significance and therapeutic options]. 1198 33

Chronic cough is defined as persistence of the symptom for longer than one month. It is a common reason for consultation. A systematic diagnostic approach based on the history, clinical examination and a number of investigations (chest x-ray, lung function tests, oesophageal pH monitoring and sinus x-rays) reveals the cause in most cases. The main aetiologies are post-nasal drip, gastro-oesophageal reflex, asthma, chronic bronchitis, and the use of angiotensin converting enzyme inhibitors. Nevertheless, in some cases, the cause is not found. In this situation it is necessary to search for less common pathologies where cough is just a symptom of systemic disease, such as connective tissue disorder (Sjogren's syndrome, atrophic polychondritis), vasculitis (Wegener's granulomatosis), Horton's syndrome (cluster headaches), amyloidosis and inflammatory bowel disease. It may also be a matter of local pathology of the tracheo-bronchial tree, such as tracheo-bronchomegaly, tracheopathia osteoplastica, rare or unrecognized infections (whooping cough, post-viral cough, bronchial tuberculosis), reactive bronchial dysfunction, eosinophilic bronchitis or radiologically occult bronchial carcinoma. Il is also necessary to consider vocal cord dysfunction and cough due to medication before accepting a diagnosis of psychogenic cough.
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PMID:[Unrecognized causes of chronic cough]. 1204 Mar 21

Gastro-esophageal reflux disease (GERD) and postnasal drip syndrome (PNDS) are common causes of chronic cough. In patients with normal chest radiographs, GERD most likely causes cough by an esophageal-bronchial reflex. When GERD causes cough, there may be no gastrointestinal symptoms up to 75% of the time. While 24-h esophageal pH monitoring is the most sensitive and specific test in linking GERD and cough in a cause and effect relationship, it has its limitations. There is no general agreement on how to best interpret the test and it cannot detect non-acid reflux events. While some patients improve with minimal medical therapy, others require intensive regimens. Surgery may be efficacious when intensive medical therapy has failed. Because there are no pathognomonic findings of PNDS, the diagnosis is inferential and is based upon a combination of clinical findings, the results of ancillary testing, and the response to specific therapy. Specific therapy depends upon the rhinosinus disease(s) causing the PND. A common error in managing PNDSs is to assume that all H(1)-antagonists are equally efficacious. The second-generation, relatively non-sedating H(1)-antagonists have been found to be less effective than the first-generation agents in treating cough due to non-histamine-mediated PNDSs.
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PMID:Diagnosis and treatment of chronic cough due to gastro-esophageal reflux disease and postnasal drip syndrome. 1209 81

On systematic investigation, patients with persistent cough are often diagnosed as having asthma, gastro-oesophageal reflux (GOR) and post-nasal drip; often, there is no associated diagnosis. Cough-variant asthma and eosinophilic bronchitis are conditions presenting with cough, usually associated with airway eosinophilia and responding well to corticosteroids. These conditions including asthma are best grouped as 'eosinophil-associated cough'. Analysis of induced sputum for eosinophils is an important tool in the investigation of chronic persistent cough. Reliable ambulatory counters for cough have been developed and the contribution of cough count and intensity to the severity of cough have been partly evaluated, and used in assessing antitussive therapies. Self-scoring evaluations are still widely used, but the inclusion of quality of life tools specifically adapted to the evaluation of cough appears to be a useful tool that can directly measure the impact of chronic cough. We need a greater assessment and evaluation of all these tools.
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PMID:Assessment and measurement of cough: the value of new tools. 1209 81

All children cough, but most children are normal. In a child with isolated cough, a detailed history and examination, followed in a small number of cases by targeted investigations, should allow the child to be placed in one of five diagnostic categories. These are normal child; the child with a serious illness such as cystic fibrosis, tuberculosis etc. the child with non-serious, but treatable causes of cough and wheeze, for example gastro-oesophageal reflux or postnasal drip; the child with an asthma syndrome and an overestimation of symptoms for psychological or other reasons by either or both of child or family. Treatment is of the underlying condition if appropriate. Non-specific treatment with cough syrups are not useful. Attention to environmental factors such as active and passive smoking, and exposure to dust and pets is important. The diagnosis of cough variant asthma should only be made in older children after variable airflow obstruction and response to bronchodilator has been demonstrated physiologically. In younger children, rational diagnostic criteria are an abnormally increased cough, with no evidence of any non-asthma diagnosis, a clear-cut response to a therapeutic trial of asthma medication, usually moderate dose inhaled corticosteroids, and relapse on stopping medications with second response to recommencing them. Some such children go on to develop more typical asthma, with wheeze and bronchial hyper-reactivity. It is important however, not to over-diagnose asthma in children who in fact have a chronic non-specific cough. Such children require no treatment, get better with time, and have normal long-term lung function.
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PMID:Paediatric problems of cough. 1209 84


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