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Abstract
Cough is a common symptom often confronted in the clinical setting. Time and resources attributed to cough place an undue burden on patients and the health care system. One characteristic of cough that likely contributes to this is the multifactorial nature of cough. Physicians are trained to find a single diagnosis to explain symptoms. With cough, if all factors contributing are not identified and treated together, the cough often remains unresolved. This article provides a practical approach to treatment and management of cough, emphasizing causes and potentiators.
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Affiliation(s)
- Baotran B Tran
- Division of Allergy-Immunology, Northwestern Medicine, Chicago, IL, USA
| | - Anne Marie Ditto
- Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, 211 East Ontario Ste. 1000, Chicago, IL 60611, USA.
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Lahousse L, Bahmer T, Cuevas-Ocaña S, Flajolet P, Mathioudakis AG, McDonnell M, Uller L, Schleich F, Dortas Junior S, Idzko M, Singh D, Ricciardolo FL, Adcock IM, Usmani O, Spanevello A, Bonvini SJ. ERS International Congress, Madrid, 2019: highlights from the Airway Diseases, Asthma and COPD Assembly. ERJ Open Res 2020; 6:00341-2019. [PMID: 32083111 PMCID: PMC7024762 DOI: 10.1183/23120541.00341-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 01/14/2020] [Indexed: 11/05/2022] Open
Abstract
The European Respiratory Society (ERS) International Congress 2019 in Madrid, Spain, was a platform for scientific discussion of the highest quality scientific research, cutting-edge techniques and innovative new therapies within the respiratory field. This article discusses some of the high-quality research studies presented at that Congress, with a focus on airway diseases, including asthma, COPD, small airways, bronchiectasis and cough, presented through the Airway Diseases, Asthma and COPD Assembly (Assembly 5) of the ERS. The authors establish the key take-home messages of these studies, compare their findings and place them into context of current understanding.
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Affiliation(s)
- Lies Lahousse
- Dept of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Thomas Bahmer
- University Hospital Schleswig-Holstein Campus Kiel, Dept for Internal Medicine I, Kiel, Germany; Member of the German Center for Lung Research (DZL)
| | - Sara Cuevas-Ocaña
- Wolfson Centre for Stem cells, Tissue Engineering and Modelling (STEM), Dept of Stem Cell Biology, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham Biodiscovery Institute, Nottingham, UK
| | - Pauline Flajolet
- Respiratory Pharmacology, National Heart and Lung Institute, Imperial College London, London, UK
| | - Alexander G. Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Melissa McDonnell
- Dept of Respiratory Medicine, Galway University Hospitals, Galway, Ireland
| | - Lena Uller
- Respiratory Immunopharmacology, Dept of Experimental Medical Science, Lund University, Lund, Sweden
| | - Florence Schleich
- Dept of Respiratory Medicine, CHU Sart-Tilman Liege, GIGA I3, Liege, Belgium
| | - Sergio Dortas Junior
- Serviço de Imunologia, Hospital Universitário Clementino Fraga Filho (HUCFF-UFRJ), Rio de Janeiro, Brazil
- Universidade Iguaçu (UNIG), Nova Iguaçu, Brazil
| | - Marco Idzko
- Dept of Pneumology, Medical University of Vienna, Vienna, Austria
| | - Dave Singh
- Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Fabio L.M. Ricciardolo
- Dept of Clinical and Biological Sciences, Azienda Ospedaliera Universitaria (AOU) San Luigi Hospital, University of Torino, Turin, Italy
| | - Ian M. Adcock
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Omar Usmani
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Antonio Spanevello
- University of Insubria, Istituti Clinici Scientifici Maugeri, IRCCS, Varese, Italy
| | - Sara J. Bonvini
- Respiratory Pharmacology, National Heart and Lung Institute, Imperial College London, London, UK
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3
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Abstract
Chronic cough is common and impactful, frustrating both patients and clinicians. An empirical trial of therapy is often done with inhaled corticosteroids, but this practice should be replaced with attempting to make an accurate diagnosis. The three most common causes are upper airway cough syndrome, asthma, and gastroesophageal reflux disease (GERD), but there are often multiple causes involved. Minimal investigations after history, physical exam, travel history, and drug history include a chest radiograph and spirometry. Empirical trial of therapy with inhaled corticosteroids is reasonable if there is evidence of eosinophilic inflammation. Empiric therapy for GERD may also be reasonable in those with symptoms. Red flags should especially be considered an urgency to make the correct diagnosis.
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