ABSTRACT
STUDY OBJECTIVES: Cough is the most common complaint for which patients in the United States seek medical attention. Although the significant effect of cough on quality of life has been reported, the association of chronic cough with depressive symptomatology has not previously been investigated. DESIGN: Prospective, nonrandomized evaluation. SETTING: Outpatient department of academic medical center. PATIENTS: Representative sample of patients presenting to a specialty center seeking evaluation and treatment of chronic cough. INTERVENTIONS: Participants completed the Center for Epidemiologic Studies Depression Scale (CES-D), a 20-item self-report questionnaire designed to measure depressive symptomatology and risk for clinical depression, on initial evaluation and again after 3 months. Patients also provided subjective cough scores reflecting the severity of their cough. MEASUREMENTS AND RESULTS: Of 100 patients undergoing initial evaluation, 53% scored positive (>/= 16) on the CES-D. Mean CES-D score was 18.3 +/- 13.2 (+/- SD). Among 81 subjects followed up at 3 months, mean CES-D score fell to 7.4 +/- 10.4, and subjective cough score decreased from 10 to 4.9 +/- 3.1. There was a statistically significant improvement in both cough and depression scores after 3 months (p < 0.001). Improvement in cough score correlated significantly with improvement in depression score (p = 0.003; Spearman rho = 0.323). CONCLUSION: Depressive symptomatology is very common in patients with chronic cough. Physicians and other caregivers must be aware of the significant risk of clinical depression in this patient population.
Subject(s)
Cough/psychology , Depressive Disorder/diagnosis , Adult , Aged , Aged, 80 and over , Chronic Disease , Depressive Disorder/psychology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Personality Inventory , Prospective Studies , Quality of Life/psychology , Remission, Spontaneous , Risk Factors , Sick Role , Statistics as TopicABSTRACT
A 61-year-old woman who was a New York City hospital employee developed fatal inhalational anthrax, but with an unknown source of anthrax exposure. The patient presented with shortness of breath, malaise, and cough that had developed 3 days prior to admission. Within hours of presentation, she developed respiratory failure and septic shock and required mechanical ventilation and vasopressor therapy. Spiral contrast-enhanced computed tomography of the chest demonstrated large bilateral pleural effusions and hemorrhagic mediastinitis. Blood cultures, as well as DNA amplification by polymerase chain reaction of the blood, bronchial washings, and pleural fluid specimens, were positive for Bacillus anthracis. The clinical course was complicated by liver failure, renal failure, severe metabolic acidosis, disseminated intravascular coagulopathy, and cardiac tamponade, and the patient died on the fourth hospital day. The cause of death was inhalational anthrax. Despite epidemiologic investigation, including environmental samples from the patient's residence and workplace, no mechanism for anthrax exposure has been identified.
