Acercamiento a la tos crónica en adultos / An approach to chronic cough

RESUMEN La tos crónica en los adultos puede ser causada por muchas causas, existen cuatro principales: el síndrome de tos de la vía aérea superior, enfermedad por reflujo gastroesofágico, reflujo laringofaríngeo, asma bronquial, y bronquitis eosinofílica no asmática. Todos los pacientes deben evaluarse clínicamente con espirometria, y comenzar con tratamiento empírico. Otras causas potenciales incluyen el uso de inhibidores de la enzima convertidora de la angiotensina, cambios medioambientales, uso del tabaco, enfermedad pulmonar obstructiva crónica, y la apnea obstructiva del sueño. La radiografía del tórax puede orientar hacia causas infecciosas, inflamatorias, y malignas. Los pacientes con tos crónica refractaria pueden remitirse a la consulta especializada de un neumólogo u otorrinolaringólogo, además de un ensayo terapéutico con gabapentin, pregabalin, y psicoterapia.

ABSTRACT Although chronic cough in adults can be caused by many etiologies, four conditions account for most cases: upper airway cough syndrome, gastro-esophageal reflux disease, also known as laryngo- pharyngeal reflux disease, bronchial asthma, and non-asthmatic eosinophilic bronchitis. All patients should be evaluated clinically with spirometry, and empiric treatment should be initiated. Other potential causes include angiotensin-converting enzyme inhibitor use, environmental triggers, tobacco use, chronic obstructive pulmonary disease, and obstructive sleep apnea. Chest radiography can rule out concerning infectious, inflammatory, and malignant thoracic conditions. Patients with refractory chronic cough should be referred to a pulmonologist or otolaryngologist in addition to a therapeutic trial of gabapentin, pregabalin, and psychotherapy.

Tosse psicogênica em criança: relato de caso / Psychogenic cough in a child: case report

Objetivos: descrever um caso de tosse psicogênica em uma criança que recebeu o diagnóstico inicial de asma persistente não contolada. Descrição do caso: paciente feminina, oito anos, com diagnóstico prévio de asma persistente, foi encaminhada para investigação e manejo ambulatorial. Os exames laboratóriais, de imagem e de função pulmonar encontravam-se normais. Foi realizado o diagnóstico de tosse psicogênica pela ausência de sintomas durante o sono e pela exclusão de outras causas. Após o tratamento com medicamento antidepressivo e apoio psiquiátrico, a paciente apresentou resolução do quadro em poucas semanas. Conclusões: apesar de infrequente, a tosse psicogênica deve sempre fazer parte do diagnóstico diferencial de tosse crônica na infância. Por se tratar de um diagnóstico de exclusão, faz-se necessário pesquisar outras causas de tosse persistente antes de confirmar este diagnóstico. São necessários mais estudos para aperfeiçoar a abordagem e gerar mais evidências no manejo desta condição na infância.

Pattern of drug abuse in patients with psychogenic cough

The present study was conduced with aims to find out the pattern of symptoms and drug abuse in patients suffering from psychogenic cough. A cross sectional descriptive study A tertiary care teaching hospital In the present study, a series of thirty two cases of psychogenic cough is reported. Of 32 cases, there were 19 females [59.4%] and 13 males [40.6%]. A majority of patients had cough for more than one month. School phobia [in children] and fear of rejection and need for attention were the commonest precipitating or perpetuating factors. Seventeen patients [53.1%] had a psychiatric disorder, the commonest being conversion disorder [21.9%] followed by mixed anxiety and depressive disorder [12.5%]. Drug therapy and/or psychotherapy were used as treatment with, 12 cases [37.5%] showing remission, 16 cases [50.0%] having improvement and 4 cases [12.5%] continuing with the complaint. Psychogenic cough needs timely recognition and appropriate treatment to avoid drug abuse. Further studies are warranted to study the treatment and outcome of this important psychiatric disorder