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Quigley N, Mistry SG, Vasant DH, Vasani S. Practical multidisciplinary framework for the assessment and management of patients with unexplained chronic aerodigestive symptoms. BMJ Open Gastroenterol 2023; 10:e000883. [PMID: 37996120 PMCID: PMC10668155 DOI: 10.1136/bmjgast-2022-000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE Patients experiencing unexplained chronic throat symptoms (UCTS) are frequently referred to gastroenterology and otolaryngology outpatient departments for investigation. Often despite extensive investigations, an identifiable structural abnormality to account for the symptoms is not found. The objective of this article is to provide a concise appraisal of the evidence-base for current approaches to the assessment and management of UCTS, their clinical outcomes, and related healthcare utilisation. DESIGN This multidisciplinary review critically examines the current understanding of aetiological theories and pathophysiological drivers in UCTS and summarises the evidence base underpinning various diagnostic and management approaches. RESULTS The evidence gathered from the review suggests that single-specialty approaches to UCTS inadequately capture the substantial heterogeneity and pervasive overlaps among clinical features and biopsychosocial factors and suggests a more unified approach is needed. CONCLUSION Drawing on contemporary insights from the gastrointestinal literature for disorders of gut-brain interaction, this article proposes a refreshed interdisciplinary approach characterised by a positive diagnosis framework and patient-centred therapeutic model. The overarching aim of this approach is to improve patient outcomes and foster collaborative research efforts.
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Affiliation(s)
- Nathan Quigley
- Otolaryngology Department, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
| | - Sandeep G Mistry
- Department of Ear Nose and Throat, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Dipesh H Vasant
- Neurogastroenterology Unit, Gastroenterology Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Sarju Vasani
- Otolaryngology Department, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
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2
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Chung KF, McGarvey L, Song WJ, Chang AB, Lai K, Canning BJ, Birring SS, Smith JA, Mazzone SB. Cough hypersensitivity and chronic cough. Nat Rev Dis Primers 2022; 8:45. [PMID: 35773287 PMCID: PMC9244241 DOI: 10.1038/s41572-022-00370-w] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 12/13/2022]
Abstract
Chronic cough is globally prevalent across all age groups. This disorder is challenging to treat because many pulmonary and extrapulmonary conditions can present with chronic cough, and cough can also be present without any identifiable underlying cause or be refractory to therapies that improve associated conditions. Most patients with chronic cough have cough hypersensitivity, which is characterized by increased neural responsivity to a range of stimuli that affect the airways and lungs, and other tissues innervated by common nerve supplies. Cough hypersensitivity presents as excessive coughing often in response to relatively innocuous stimuli, causing significant psychophysical morbidity and affecting patients' quality of life. Understanding of the mechanisms that contribute to cough hypersensitivity and excessive coughing in different patient populations and across the lifespan is advancing and has contributed to the development of new therapies for chronic cough in adults. Owing to differences in the pathology, the organs involved and individual patient factors, treatment of chronic cough is progressing towards a personalized approach, and, in the future, novel ways to endotype patients with cough may prove valuable in management.
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Affiliation(s)
- Kian Fan Chung
- Experimental Studies Unit, National Heart & Lung Institute, Imperial College London, London, UK
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospital, London, UK
| | - Lorcan McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland's University of Technology and Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Division of Child Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Kefang Lai
- The First Affiliated Hospital of Guangzhou Medical University, National Center of Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | | | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Stuart B Mazzone
- Department of Anatomy and Physiology, University of Melbourne, Victoria, Australia.
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3
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Johansson H, Johannessen A, Holm M, Forsberg B, Schlünssen V, Jõgi R, Clausen M, Lindberg E, Malinovschi A, Emilsson ÖI. Prevalence, progression and impact of chronic cough on employment in Northern Europe. Eur Respir J 2021; 57:13993003.03344-2020. [PMID: 33303532 DOI: 10.1183/13993003.03344-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/12/2020] [Indexed: 11/05/2022]
Abstract
We investigated the prevalence of chronic cough and its association with work ability and sick leave in the general population.Data were analysed from the Respiratory Health In Northern Europe (RHINE) III cohort (n=13 500), of which 11 252 participants had also participated in RHINE II 10 years earlier, a multicentre study in Northern Europe. Participants answered a questionnaire on chronic cough, employment factors, smoking and respiratory comorbidities.Nonproductive chronic cough was found in 7% and productive chronic cough in 9% of the participants. Participants with nonproductive cough were more often female and participants with productive cough were more often smokers and had a higher body mass index (BMI) than those without cough. Participants with chronic cough more often reported >7 days of sick leave in the preceding year than those without cough ("nonproductive cough" 21% and "productive cough" 24%; p<0.001 for comparisons with "no cough" 13%). This pattern was consistent after adjusting for age, sex, BMI, education level, smoking status and comorbidities. Participants with chronic cough at baseline reported lower work ability and more often had >7 days of sick leave at follow-up than those without cough. These associations remained significant after adjusting for cough at follow-up and other confounding factors.Chronic cough was found in around one in six participants and was associated with more sick leave. Chronic cough 10 years earlier was associated with lower work ability and sick leave at follow-up. These associations were not explained by studied comorbidities. This indication of negative effects on employment from chronic cough needs to be recognised.
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Affiliation(s)
- Henrik Johansson
- Dept of Neuroscience, Uppsala University, Uppsala, Sweden.,Clinical Physiology, Dept of Medical Sciences, Uppsala University, Uppsala, Sweden.,Respiratory, Allergy and Sleep Research, Dept of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ane Johannessen
- Centre for International Health, Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Mathias Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bertil Forsberg
- Sustainable Health, Dept of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Vivi Schlünssen
- Dept of Public Health, Section for Environment, Occupation and Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark
| | - Rain Jõgi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Michael Clausen
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Eva Lindberg
- Respiratory, Allergy and Sleep Research, Dept of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Clinical Physiology, Dept of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Össur Ingi Emilsson
- Respiratory, Allergy and Sleep Research, Dept of Medical Sciences, Uppsala University, Uppsala, Sweden .,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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4
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Sandage MJ, Ostwalt ES, Allison LH, Cutchin GM, Morton ME, Odom SC. Irritant-Induced Chronic Cough Triggers: A Scoping Review and Clinical Checklist. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1261-1291. [PMID: 33989029 DOI: 10.1044/2021_ajslp-20-00362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The primary aim of this review was to identify environmental irritants known to trigger chronic cough through the life span and develop a comprehensive clinically useful irritant checklist. Method A scoping review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews, checklist, and explanation. English-language, full-text resources were identified through Medline, PsycINFO, SPORTDiscus, Web of Science, and ProQuest Dissertations and Theses Global. Results A total of 1,072 sources were retrieved; of these, 109 were duplicates. Titles of abstracts of 963 articles were screened, with 295 selected for full-text review. Using the exclusion and inclusion criteria listed, 236 articles were considered eligible and 214 different triggers were identified. Triggers were identified from North America, Europe, Africa, Asia, and Australia. Occupational exposures were also delineated. Conclusions A clinically useful checklist of both frequently encountered triggers and idiosyncratic or rare triggers was developed. The clinical checklist provides a unique contribution to streamline and standardize clinical assessment of irritant-induced chronic cough. The international scope of this review extends the usefulness of the clinical checklist to clinicians on most continents.
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Affiliation(s)
- Mary J Sandage
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| | | | - Lauren H Allison
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| | - Grace M Cutchin
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| | | | - Shelby C Odom
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
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5
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Tanno LK, Chalmers R, Jacob R, Kostanjsek N, Bierrenbach AL, Martin B, Molinari N, Annesi‐Maesano I, Papadopoulos NG, Sanchez‐Borges M, Rosenwasser LJ, Ansontegui I, Ebisawa M, Sisul JC, Jares E, Gomez M, Agache I, Muraro A, Wong GWK, Thien F, Pawankar R, Mahr TA, Sublett JL, Lang DM, Casale T, Demoly P. Global implementation of the world health organization's International Classification of Diseases (ICD)-11: The allergic and hypersensitivity conditions model. Allergy 2020; 75:2206-2218. [PMID: 32578235 DOI: 10.1111/all.14468] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 12/21/2022]
Abstract
The International Classification of Diseases (ICD) provides a common language for use worldwide as a diagnostic and classification tool for epidemiology, clinical purposes and health management. Since its first edition, the ICD has maintained a framework distributing conditions according to topography, with the result that some complex conditions, such as allergies and hypersensitivity disorders (A/H) including anaphylaxis, have been poorly represented. The change in hierarchy in ICD-11 permitted the construction of the pioneer section addressed to A/H, which may result in more accurate mortality and morbidity statistics, including more accurate accounting for mortality due to anaphylaxis, strengthen classification, terminology and definitions. The ICD-11 was presented and adopted by the 72nd World Health Assembly in May 2019, and the implementation is ongoing worldwide. We here present the outcomes from an online survey undertaken to reach out the allergy community worldwide in order to peer review the terminology, classification and definitions of A/H introduced into ICD-11 and to support their global implementation. Data are presented here for 406 respondents from 74 countries. All of the subsections of the new A/H section of the ICD-11 had been considered with good accuracy by the majority of respondents. We believe that, in addition to help during the implementation phase, all the comments provided will help to improve the A/H classification and to increase awareness by different disciplines of what actions are needed to ensure more accurate epidemiological data and better clinical management of A/H patients.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio‐Libanês São Paulo Brazil
- University Hospital of Montpellier Montpellier France
- INSERM UMR‐S 1136 IPLESP Equipe EPAR Sorbonne Université Paris France
- WHO Collaborating Centre on Scientific Classification Support Montpellier France
- ICD‐11 Medical and Scientific Advisory Committee WHO Geneva Switzerland
| | - Robert Chalmers
- ICD‐11 Medical and Scientific Advisory Committee WHO Geneva Switzerland
- Centre for Dermatology University of Manchester Manchester UK
| | - Robert Jacob
- Classifications, Terminologies and Standards World Health Organization Geneva Switzerland
| | - Nenad Kostanjsek
- Classifications, Terminologies and Standards World Health Organization Geneva Switzerland
| | - Ana Luiza Bierrenbach
- Hospital Sírio‐Libanês São Paulo Brazil
- Sanas Epidemiology and Research São Paulo Brazil
- Teaching Research Institute (IEP) Hospital Sírio Libanês São Paulo Brazil
| | - Bryan Martin
- Medicine and Pediatrics The Ohio State University in Columbus Columbus OH USA
| | | | | | - Nikolaos G. Papadopoulos
- Centre for Paediatrics and Child Health Institute of Human Development University of Manchester Manchester UK
- Department of Allergy 2nd Pediatric Clinic University of Athens Athens Greece
| | - Mario Sanchez‐Borges
- Allergy and Clinical Immunology Department Centro Medico Docente La Trinidad Caracas Venezuela
| | - Lanny J. Rosenwasser
- Division of Immunology Research Department of Pediatrics Children's Mercy Hospitals & Clinics Kansas City MO USA
| | - Ignacio Ansontegui
- Department of Allergy and Immunology Hospital Quirónsalud Bizkaia Erandio Bilbao Spain
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital Sagamihara Japan
| | - Juan Carlos Sisul
- Latinalerican Society of Allergy, Asthma and Immunology Villarica Paraguay
- American College of Allergy, Asthma and Immunology Arlington Heights IL USA
| | - Edgardo Jares
- LIBRA Foundation and CMP SA Buenos Aires Buenos Aires Argentina
| | - Maximiliano Gomez
- Research & Education Fundación Ayre Allergy & Asthma Unit Hospital San Bernardo Catholic University of Salta Salta Argentina
| | | | - Antonella Muraro
- Department of Women and Child Health Food Allergy Referral Centre Veneto Region Padua General University Hospital Padua Italy
| | - Gary W. K. Wong
- Department of Pediatrics Chinese University of Hong Kong Hong Kong China
| | - Francis Thien
- Faculty of Medicine, Nursing and Health Sciences Monash University Clayton Vic Australia
- Department of Respiratory Medicine Eastern Health Box Hill Vic. Australia
| | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Todd A. Mahr
- Pediatric Allergy and Clinical Immunology Gundersen Health System in La Crosse La Crosse WI USA
| | - James L. Sublett
- Family Allergy & Asthma Louisville KY USA
- Department of Pediatrics Section of Allergy & Immunology University of Louisville School of Medicine Louisville KY USA
| | - David M. Lang
- Department of Allergy and Clinical Immunology Respiratory Institute Cleveland Clinic OH USA
| | - Thomas Casale
- Morsani College of Medicine University of South Florida Tampa FL USA
| | - Pascal Demoly
- University Hospital of Montpellier Montpellier France
- INSERM UMR‐S 1136 IPLESP Equipe EPAR Sorbonne Université Paris France
- WHO Collaborating Centre on Scientific Classification Support Montpellier France
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6
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Lai K, Long L. Current Status and Future Directions of Chronic Cough in China. Lung 2020; 198:23-29. [PMID: 31912413 DOI: 10.1007/s00408-019-00319-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/20/2019] [Indexed: 12/16/2022]
Abstract
Chronic cough is one of the most common complaints for which patients in China seek medical attention. However, there are no nationwide data on the prevalence and socioeconomic burden of chronic cough. Although approximately 50% of Chinese men smoke, the vast majority of patients presenting for evaluation of chronic cough are never smokers. An equal sex distribution and a middle-aged predominance have been observed in the Chinese chronic cough population, despite demonstration of a higher cough reflex sensitivity in females and older patients. The role of air pollution in the distinct age and sex distribution requires further study. In terms of the etiologies of chronic cough in China, cough-variant asthma, upper airway cough syndrome, nonasthmatic eosinophilic bronchitis, and atopic cough are the most common causes, comprising 75.2% to 87.6% of cases across different regions. Chinese Guidelines for Diagnosis and Treatment of Cough were initially published in 2005, and updated in 2009 and 2016. In addition, the China Cough Coalition was established in 2016. Great progress has been made in both cough-related clinical practice and research in recent years, however, there are still challenges ahead. To facilitate optimal management of chronic cough in China, efforts promoting the dissemination and application of published guidelines will be essential, especially in community-based healthcare and in rural regions. As chronic refractory cough has been identified as a huge challenge to clinicians worldwide, continued international cooperation will be essential in optimizing evaluation and management of chronic cough.
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Affiliation(s)
- Kefang Lai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd., Guangzhou, 510120, China.
| | - Li Long
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd., Guangzhou, 510120, China
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7
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Nynäs P, Vilpas S, Kankare E, Karjalainen J, Lehtimäki L, Numminen J, Tikkakoski A, Kleemola L, Uitti J. Observational cross-sectional study on Symptoms Associated to Moisture DAmage at Workplace: the SAMDAW study protocol. BMJ Open 2019; 9:e026485. [PMID: 31243032 PMCID: PMC6597744 DOI: 10.1136/bmjopen-2018-026485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Moisture damage (MD) exposure at work has been shown to increase the risk of new onset asthma and exacerbation of asthma. However, most of the studies in this field have been questionnaire studies. A small proportion of MD-exposed workers are diagnosed with asthma. Many patients with MD exposure at work referred to secondary healthcare report intermittent hoarseness, loss of voice or difficulty to inhale, referring to functional or organic problems of the larynx. For accurate treatment, proper differential diagnostics is paramount. We present an ongoing observational study in which we describe the prevalence of respiratory, voice and other symptoms related to MD at work in patients referred to secondary healthcare. Case-control setting will be used to evaluate the frequencies of the background factors, bronchial hyperreactivity and laryngeal findings. METHODS AND ANALYSIS The study sample consists of patients with workplace MD exposure and associated respiratory tract and/or voice symptoms referred to Tampere University Hospital. The clinical tests conducted to the study patients included comprehensive lung function tests, laboratory and skin prick tests, imaging and clinical evaluation by specialists of respiratory medicine, oto-rhino-laryngology and phoniatrics. The exposure assessment was performed by an occupational physician. The study patients filled out a questionnaire on previous illnesses and other background factors, which for comparison was also sent to 1500 Finnish-speaking people in the same hospital district randomly selected by the Finnish Population Information System. To explore how common laryngeal disorders and voice symptoms are in general, a part of the tests will be conducted to 50 asymptomatic volunteers. ETHICS AND DISSEMINATION The regional ethics committee of Tampere University Hospital approved the study. All study subjects gave their written informed consent, which is required also from the controls. The results will be communicated locally and internationally as conference papers and journal articles.
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Affiliation(s)
- Pia Nynäs
- Department of Occupational Medicine, Finnish Institute of Occupational Health, Tampere, Finland
- Department of Occupational Medicine, Tampere University Hospital, Tampere, Finland
| | - Sarkku Vilpas
- Department of Phoniatrics, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Elina Kankare
- Department of Phoniatrics, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Jura Numminen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Antti Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Leenamaija Kleemola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jukka Uitti
- Department of Occupational Medicine, Finnish Institute of Occupational Health, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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8
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Tarlo SM. Occupational and Environmental Exposures and Their Role in Chronic Cough. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00242-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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9
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Vocal cord dysfunction and bronchial asthma. КЛИНИЧЕСКАЯ ПРАКТИКА 2018. [DOI: 10.17816/clinpract9474-79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The syndromology of dysfunction of the vocal cords varies widely from the absence of symptoms to mild shortness of breath to acute respiratory disfunction, which can mimic an asthma attack. The treatment of vocal dysfunction and bronchial asthma is different. An early fold diagnosis of vocal dysfunction can prevent improper treatment and, therefore, minimize the rising costs of health care.
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Perotin JM, Launois C, Dewolf M, Dumazet A, Dury S, Lebargy F, Dormoy V, Deslee G. Managing patients with chronic cough: challenges and solutions. Ther Clin Risk Manag 2018; 14:1041-1051. [PMID: 29922064 PMCID: PMC5995432 DOI: 10.2147/tcrm.s136036] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Chronic cough is a common complaint and a frequent cause of medical consultation. Its management can be difficult. We present here an overview of the current guidelines for the management of chronic cough. Different steps are detailed, including the initial research of an obvious etiology and alert signs that should lead to further investigation of underlying condition. The diagnosis of the most frequent causes: asthma, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux disease and upper airway cough syndrome should be considered, assessed and treated accordingly. Recent advances have been made in the comprehension of refractory chronic cough pathophysiology as well as its pharmacologic and non-pharmacologic treatment, especially speech pathology therapy.
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Affiliation(s)
- Jeanne-Marie Perotin
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France.,INSERM UMRS 1250, University Hospital of Reims, Reims, France
| | - Claire Launois
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
| | - Maxime Dewolf
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
| | - Antoine Dumazet
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
| | - Sandra Dury
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
| | - François Lebargy
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
| | - Valérian Dormoy
- INSERM UMRS 1250, University Hospital of Reims, Reims, France
| | - Gaëtan Deslee
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France.,INSERM UMRS 1250, University Hospital of Reims, Reims, France
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11
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Balogun RA, Siracusa A, Shusterman D. Occupational rhinitis and occupational asthma: Association or progression? Am J Ind Med 2018; 61:293-307. [PMID: 29411403 DOI: 10.1002/ajim.22819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Occupational asthma is the most frequently reported occupational respiratory disease in registries, and is often co-diagnosed with occupational rhinitis. We undertook a systematic review of the English-language epidemiologic literature linking these two conditions, with emphasis on progression from occupational rhinitis to occupational asthma. METHODS PubMed and Embase were queried in a series of structured searches designed to identify studies comparing occupational asthma and occupational rhinitis incidence or prevalence in occupationally exposed individuals. RESULTS The searches yielded a total of 109 unique citations, 15 of which yielded inferential data on the occupational rhinitis-asthma relationship. Nine of fifteen studies showed statistically significant associations between the occurrence of occupational rhinitis and occupational asthma among individual workers. CONCLUSIONS Limited data support the notion that occupational rhinitis precedes the development of occupational asthma, particularly when high-molecular-weight (HMW) agents are involved. The relationship between the two conditions could not be evaluated in many relevant studies due to a lack of cross-tabulation of individual cases.
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Affiliation(s)
- Rahmat A. Balogun
- Division of Occupational and Environmental Medicine; University of California; San Francisco California
| | | | - Dennis Shusterman
- Division of Occupational and Environmental Medicine; University of California; San Francisco California
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12
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Tarlo SM, Altman KW, Oppenheimer J, Lim K, Vertigan A, Prezant D, Irwin RS. Occupational and Environmental Contributions to Chronic Cough in Adults: Chest Expert Panel Report. Chest 2016; 150:894-907. [PMID: 27521735 DOI: 10.1016/j.chest.2016.07.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/15/2016] [Accepted: 07/15/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In response to occupational and environmental exposures, cough can be an isolated symptom reflecting exposure to an irritant with little physiological consequence, or it can be a manifestation of more significant disease. This document reviews occupational and environmental contributions to chronic cough in adults, focusing on aspects not previously covered in the 2006 ACCP Cough Guideline or our more recent systematic review, and suggests an approach to investigation of these factors when suspected. METHODS MEDLINE and TOXLINE literature searches were supplemented by articles identified by the cough panel occupational and environmental subgroup members, to identify occupational and environmental aspects of chronic cough not previously covered in the 2006 ACCP Cough Guideline. Based on the literature reviews and the Delphi methodology, the cough panel occupational and environmental subgroup developed guideline suggestions that were approved after review and voting by the full cough panel. RESULTS The literature review identified relevant articles regarding: mechanisms; allergic environmental causes; chronic cough and the recreational and involuntary inhalation of tobacco and marijuana smoke; nonallergic environmental triggers; laryngeal syndromes; and occupational diseases and exposures. Consensus-based statements were developed for the approach to diagnosis due to a lack of strong evidence from published literature. CONCLUSIONS Despite increased understanding of cough related to occupational and environmental triggers, there remains a gap between the recommended assessment of occupational and environmental causes of cough and the reported systematic assessment of these factors. There is a need for further documentation of occupational and environmental causes of cough in the future.
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Affiliation(s)
- Susan M Tarlo
- Division of Respiratory Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
| | - Kenneth W Altman
- Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, TX
| | - John Oppenheimer
- Division of Allergy and Immunology, University of Medicine and Dentistry of New Jersey-Rutgers University, Newark, NJ
| | - Kaiser Lim
- Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Mayo College of Medicine, Rochester, MN
| | | | - David Prezant
- Fire Department of the City of New York, Brooklyn, NY
| | - Richard S Irwin
- Division of Pulmonary, Allergy and Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA
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Jiang M, Guan WJ, Fang ZF, Xie YQ, Xie JX, Chen H, Wei D, Lai KF, Zhong NS. A Critical Review of the Quality of Cough Clinical Practice Guidelines. Chest 2016; 150:777-788. [DOI: 10.1016/j.chest.2016.04.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/05/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022] Open
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Pignatti P, Spanevello A. Towards a practical clinical use of fractioned exhaled nitric oxide levels in chronic cough. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:357. [PMID: 27761461 DOI: 10.21037/atm.2016.08.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Patrizia Pignatti
- Allergy and Immunology Unit, Salvatore Maugeri Foundation, IRCCS, Pavia, Italy
| | - Antonio Spanevello
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy;; Pneumology Unit, Rehabilitation Institute of Tradate, Salvatore Maugeri Foundation, IRCCS, Pavia, Italy
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Tanno LK, Calderon MA, Smith HE, Sanchez-Borges M, Sheikh A, Demoly P. Dissemination of definitions and concepts of allergic and hypersensitivity conditions. World Allergy Organ J 2016; 9:24. [PMID: 27551327 PMCID: PMC4977713 DOI: 10.1186/s40413-016-0115-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Allergy and hypersensitivity can affect people of any age and manifest with problems in a range of organ systems. Moreover, they can have a significant impact on the quality of life of patients and their families. Although once rare, there is presently an epidemic of allergic disorders with associated considerable societal consequences. Our understanding of the pathophysiology of these disorders has changed substantially over the last 20 years. In the light of these developments, the Joint Allergy Academies have made concerted efforts to ensure that these are reflected in the current definitions and concepts used in clinical allergy and to ensure these are reflected in the forthcoming International Classification of Diseases-11 (ICD-11). OBJECTIVE In this review, we seek to provide an update on the current definitions and concepts in relation to allergic disorders. RESULTS Once the new section has been built in the ICD-11 to address allergic and hypersensitivity conditions, we have been moving actions to try to support awareness by disseminating updated concepts in the field. Aligned with the ICD and the WAO philosophy of being global, this document presents fundamental and broad allergy concepts to strengthen the understanding by different health professionals worldwide, besides to support the formation of in training students. CONCLUSION This current review intends to be accepted and used universally by all health professionals involved in diseases' classification and coding and, therefore, contribute to improve care and outcomes in this increasing sub-section of the world's population.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio Libanês, São Paulo, Brazil
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
- Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
| | - Moises A. Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
| | - Helen E. Smith
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
- Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
| | - on behalf of Joint Allergy Academies
- Hospital Sírio Libanês, São Paulo, Brazil
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
- Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Tanno LK, Calderon M, Demoly P. Supporting the validation of the new allergic and hypersensitivity conditions section of the World Health Organization International Classification of Diseases-11. Asia Pac Allergy 2016; 6:149-56. [PMID: 27489786 PMCID: PMC4967614 DOI: 10.5415/apallergy.2016.6.3.149] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/20/2016] [Indexed: 01/28/2023] Open
Abstract
Background The new International Classification of Diseases (ICD)-11 "Allergic and hypersensitivity conditions" section has been constructed as a result of a detailed and careful action plan based on scientific evidences for the necessity of changes and collaboration with the World Health Organization (WHO) ICD-11 revision governance. All the efforts are being acknowledged by the Joint Allergy Academies. Objective Considering the new classification model addressed to the allergic and hypersensitivity conditions and following the ICD WHO agenda, we believe it is the appropriate time to start supporting the validation process in collaboration with the WHO ICD governance. Methods We conducted a mapping of ICD-10 allergic and hypersensitivity conditions in the ICD-11 beta phase structure and categorized the conditions as fitting by "precoordination," "postcoordination," "indexed to the ICD-11 Foundation," "no code fit properly" or "no correspondence" in the ICD-11. Results From overall 125 ICD-10 entities spread in 6 chapters, 57.6% were able to be precoordinated, 4% postcoordinated, 12% indexed to the Foundation, 9.6% had no code fitting properly and 18.6% had no correspondence in the ICD-11 framework. Conclusion We have been able to demonstrate that 83.2% of the ICD-10 allergic and hypersensitivity conditions could be captured by the current ICD-11 beta draft framework. We strongly believe that our findings constitute a key step forward for a softer transition of the ICD-10 allergic and hypersensitivity conditions to the ICD-11, supporting the WHO in this process as well as strengthening the visibility of the Allergy specialty and ensuring quality management of allergic patients.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio Libanês, São Paulo 01308-050, Brazil.; Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, Montpellier, and Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, Paris, France
| | - Moises Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, Montpellier, and Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, Paris, France
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Amaral AFS, Garcia Larsen V, De Matteis S, Minelli C. Understanding the Influence of Genes, Diet, and Occupation on Respiratory Health. Am J Respir Crit Care Med 2016. [DOI: 10.1164/rccm.201604-0729rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- André F. S. Amaral
- Population Health and Occupational Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Vanessa Garcia Larsen
- Population Health and Occupational Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sara De Matteis
- Population Health and Occupational Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Cosetta Minelli
- Population Health and Occupational Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Abstract
PURPOSE OF REVIEW The purpose of this study is to review the relevant literature concerning work-associated irritable larynx syndrome (WILS), a hyperkinetic laryngeal disorder associated with occupational irritant exposure. Clinical symptoms are variable and include dysphonia, cough, dyspnoea and globus pharyngeus. WILS is a clinical diagnosis and can be difficult to differentiate from asthma. Treatment options for WILS include medical and behavioural therapy. RECENT FINDINGS Laryngeal-centred upper airway symptoms secondary to airborne irritants have been documented in the literature under a variety of diagnostic labels, including WILS, vocal cord dysfunction (VCD), laryngeal hypersensitivity and laryngeal neuropathy and many others. The underlying pathophysiology is as yet poorly understood; however, the clinical scenario suggests a multifactorial nature to the disorder. More recent literature indicates that central neuronal plasticity, inflammatory processes and psychological factors are all likely contributors. SUMMARY Possible mechanisms for WILS include central neuronal network plasticity after noxious exposure and/or viral infection, inflammation (i.e. reflux disease) and intrinsic patient factors such a psychological state. Treatment is individualized and frequently includes one or more of the following: environmental changes in the workplace, GERD therapy, behavioural/speech therapy, psychotherapy counselling and neural modifiers.
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Tarlo SM, Altman KW, French CT, Diekemper RL, Irwin RS. Evaluation of Occupational and Environmental Factors in the Assessment of Chronic Cough in Adults. Chest 2016; 149:143-60. [DOI: 10.1378/chest.15-1877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 08/30/2015] [Accepted: 09/30/2015] [Indexed: 11/01/2022] Open
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Tanno LK, Calderon MA, Goldberg BJ, Gayraud J, Bircher AJ, Casale T, Li J, Sanchez-Borges M, Rosenwasser LJ, Pawankar R, Papadopoulos NG, Demoly P. Constructing a classification of hypersensitivity/allergic diseases for ICD-11 by crowdsourcing the allergist community. Allergy 2015; 70:609-15. [PMID: 25736171 DOI: 10.1111/all.12604] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2015] [Indexed: 11/29/2022]
Abstract
The global allergy community strongly believes that the 11th revision of the International Classification of Diseases (ICD-11) offers a unique opportunity to improve the classification and coding of hypersensitivity/allergic diseases via inclusion of a specific chapter dedicated to this disease area to facilitate epidemiological studies, as well as to evaluate the true size of the allergy epidemic. In this context, an international collaboration has decided to revise the classification of hypersensitivity/allergic diseases and to validate it for ICD-11 by crowdsourcing the allergist community. After careful comparison between ICD-10 and 11 beta phase linearization codes, we identified gaps and trade-offs allowing us to construct a classification proposal, which was sent to the European Academy of Allergy and Clinical Immunology (EAACI) sections, interest groups, executive committee as well as the World Allergy Organization (WAO), and American Academy of Allergy Asthma and Immunology (AAAAI) leaderships. The crowdsourcing process produced comments from 50 of 171 members contacted by e-mail. The classification proposal has also been discussed at face-to-face meetings with experts of EAACI sections and interest groups and presented in a number of business meetings during the 2014 EAACI annual congress in Copenhagen. As a result, a high-level complex structure of classification for hypersensitivity/allergic diseases has been constructed. The model proposed has been presented to the WHO groups in charge of the ICD revision. The international collaboration of allergy experts appreciates bilateral discussion and aims to get endorsement of their proposals for the final ICD-11.
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Affiliation(s)
| | - M. A. Calderon
- Section of Allergy and Clinical Immunology; Imperial College London; National Heart and Lung Institute; Royal Brompton Hospital; London UK
| | - B. J. Goldberg
- Kaiser-Permanente Southern California Regional Allergy-Immunology Laboratory; Los Angeles, CA USA
- International Health Terminology Standards Development Organization; Los Angeles, CA USA
| | | | - A. J. Bircher
- Allergy Unit; Department of Dermatology; University Hospital Basel; Basel Switzerland
| | - T. Casale
- Internal Medicine; Morsani College of Medicine; University of South Florida; Tampa FL USA
| | - J. Li
- Division of Allergic Diseases; Mayo Clinic; Rochester MN USA
| | - M. Sanchez-Borges
- Allergy and Clinical Immunology Department; Centro Medico Docente La Trinidad; Caracas Venezuela
| | - L. J. Rosenwasser
- Division of Immunology Research; Department of Pediatrics; Children's Mercy Hospitals & Clinics; Kansas City MO USA
| | - R. Pawankar
- Division of Allergy; Department of Pediatrics; Nippon Medical School; Tokyo Japan
| | - N. G. Papadopoulos
- Centre for Paediatrics and Child Health; Institute of Human Development; University of Manchester; Manchester UK
- Department of Allergy; 2nd Pediatric Clinic; University of Athens; Athens Greece
| | - P. Demoly
- University Hospital of Montpellier; Montpellier France
- Sorbonne Universités; UPMC Paris 06; UMR-S 1136; IPLESP; Equipe EPAR; Paris France
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Abstract
Occupational rhinitis is characterized by nasal congestion, rhinorrhea, nasal itching, and/or sneezing that occur secondary to exposures in the workplace. This disease can be classified into allergic or nonallergic subgroups based upon the underlying disease pathogenesis as well as the type of causative agent. While the true prevalence of occupational rhinitis is unknown, there are certain professions and occupational exposures that place workers at a higher risk for developing the disease. Additionally, occupational rhinitis can be associated with occupational asthma and upper airway symptoms may precede those of the lower respiratory tract. Taken together, occupational rhinitis is an important disease for study given its medical as well as socioeconomic implications. This review will focus on the classification of occupational rhinitis as well the prevalence, diagnosis, and treatment strategies.
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Affiliation(s)
- Whitney W Stevens
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, 211 E Ontario St, Suite 1010, Chicago, IL, 60611, USA,
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Birring SS, Kavanagh J, Lai K, Chang AB. Adult and paediatric cough guidelines: Ready for an overhaul? Pulm Pharmacol Ther 2015; 35:137-44. [PMID: 25681276 DOI: 10.1016/j.pupt.2015.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 01/31/2015] [Indexed: 11/17/2022]
Abstract
Cough is one of the most common reasons that patients seek medical attention. Cough guidelines from numerous countries and societies are available to assist the clinician to investigate and manage patients with cough. We review some of the recent progress in the field of cough that may lead to revision of these guidelines. In adults with chronic cough, new causes such as obstructive sleep apnoea have been identified. A new terminology, cough hypersensitivity syndrome (CHS), has been proposed for patients with chronic cough, which emphasises cough reflex hypersensitivity as a key feature. New therapeutic options are now available, particularly for patients with refractory or idiopathic chronic cough, which include gabapentin, speech pathology management and morphine. There has been great progress in the assessment of cough with the development of validated quality of life questionnaires and cough frequency monitoring tools. In children, common aetiologies differ from adults and those managed according to guidelines have better outcomes compared to usual care. New diagnostic entities such as protracted bacterial bronchitis have been described. Paediatric-specific cough assessment tools such as the Parent/Child Quality of Life Questionnaire will help improve the assessment of patients. Further research is necessary to improve the evidence base for future clinical guideline recommendations. Guidelines in future should also aim to reach a wider audience that includes primary care physicians, non-specialists and patients.
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Affiliation(s)
- Surinder S Birring
- King's College London, Division of Asthma, Allergy and Lung Biology, Denmark Hill Campus, London, United Kingdom
| | - Joanne Kavanagh
- King's College London, Division of Asthma, Allergy and Lung Biology, Denmark Hill Campus, London, United Kingdom.
| | - Kefang Lai
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, 1st Affiliated Hospital, Guangzhou Medical College, GZ, China
| | - Anne B Chang
- Dept of Respiratory and Sleep Medicine, Queensland Children's Medical Research Institute, Children's Health Queensland; and Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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Tanno LK, Calderon MA, Goldberg BJ, Akdis CA, Papadopoulos NG, Demoly P. Categorization of allergic disorders in the new World Health Organization International Classification of Diseases. Clin Transl Allergy 2014; 4:42. [PMID: 25905010 PMCID: PMC4405839 DOI: 10.1186/2045-7022-4-42] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 10/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although efforts to improve the classification of hypersensitivity/allergic diseases have been made, they have not been considered a top-level category in the International Classification of Diseases (ICD)-10 and still are not in the ICD-11 beta phase linearization. ICD-10 is the most used classification system by the allergy community worldwide but it is not considered as appropriate for clinical practice. The Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) on the other hand contains a tightly integrated classification of hypersensitivity/allergic disorders based on the EAACI/WAO nomenclature and the World Health Organization (WHO) may plan to align ICD-11 with SNOMED CT so that they share a common ontological basis. METHODS With the aim of actively supporting the ongoing ICD-11 revision and the optimal practice of Allergology, we performed a careful comparison of ICD-10 and 11 beta phase linearization codes to identify gaps, areas of regression in allergy coding and possibly reach solutions, in collaboration with committees in charge of the ICD-11 revision. RESULTS We have found a significant degree of misclassification of terms in the allergy-related hierarchies. This stems not only from unclear definitions of these conditions but also the use of common names that falsely imply allergy. The lack of understanding of the immune mechanisms underlying some of the conditions contributes to the difficulty in classification. CONCLUSIONS More than providing data to support specific changes into the ongoing linearization, these results highlight the need for either a new chapter entitled Hypersensitivity/Allergic Disorders as in SNOMED CT or a high level structure in the Immunology chapter in order to make classification more appropriate and usable.
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Affiliation(s)
| | - Moises A Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
| | - Bruce J Goldberg
- Director, Kaiser-Permanente Southern California Regional Allergy-Immunology Laboratory, Consultant terminologist, International Health Terminology Standards Development Organization, Los Angeles, CA USA
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | | | - Pascal Demoly
- UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, University Hospital of Montpellier, Montpellier, and Sorbonne Universités, 75013 Paris, France
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