Initial empirical treatment based on clinical feature of chronic cough.

BACKGROUND: An empirical therapy based on the clinical characteristics of cough had not been reported. We evaluated this strategy of empirical therapy on chronic cough. METHODS: Patients with chronic cough were initially diagnosed with corticosteroid-responsive cough (CRC), postnasal drip syndrome (PNDS) and gastroesophageal reflux-related cough (GERC) based on their medical history and clinical presentation, and received a sequential three-step empirical therapy. A successful response was required for final diagnosis. RESULTS: A total of 96 patients were recruited with a median duration of cough for 4 months (range, 2-100). The primary diagnosis based on history and clinical presentation was CRC in 53 patients (55.2%), PNDS in 36 (37.5%) and GERC in 7 (7.3%). Cough improved in 60 patients (62.5%) at the first step with mean time of 6.2 ± 3.3 days. Three-step empirical therapy was beneficial in 78 of 96 (81.2%) patients at last. The final spectrum and frequency of causes of cough based on therapeutic response were as follows: CRC (46.7%), PNDS (27.5%) and GERC (10.8%). Eighteen cases (18.8%) were not responsive to empirical treatment, seven of whom were identified as other causes by diagnostic tests. CONCLUSIONS: The empirical therapy aimed at primary diagnosis on the basis of history and clinical characteristics is a more targeted approach, and leads to improvement of chronic cough more quickly in most patients. CRC is the most common cause of chronic cough.

[A retrospective study on the treatment of patients with chronic obstructive pulmonary disease by face mask mechanical ventilation].

OBJECTIVE: To assess the effect and the influencing factors in face mask mechanical ventilation (FMMV) for the treatment of COPD with respiratory failure (RF), and to compare the efficacy and efficiency of FMMV with endotracheal intubation mechanical ventilation (ETMV). METHODS: From 1991 to 2001, 4 ventilating periods were named initial, middle, late, and extending stage according to ventilators, face masks and mechanical ventilating methods. The results of FMMV in the 4 periods were compared. The results in patients with FMMV who reached the endotracheal intubation criteria were also compared with those in ETMV ones from 1988 to 1990. RESULTS: 385 patients with COPD and RF were admitted to RICU. The proportion of FMMV in all MV patients increased [48% (11/23), 79% (15/19), 85% (29/34), 91% (223/246)]; at the same time the effective rate of FMMV [46% (5/11), 67% (10/15), 83% (24/29), 89% (198/223)] and the total effective rate [71% (35/49), 71% (20/28), 81% (34/42), 88% (234/266)] also increased. 83 percent of the patients who suffered from severe disturbances of consciousness in the late and extending stage were successfully weaned from FMMV. Complications including the rates of nasal bridge erosion [27% (3/11), 13% (2/15), 7% (2/29), 2% (4/223)] and the rates of stomach distension [46% (5/11), 40% (6/15), 21% (6/29), 5% (11/223)] all decreased. The ventilation times and length of stay were significantly shorter than those in patients with ETMV. The rate of nosocomial pneumonia and the mortality of inpatients were significantly lower. CONCLUSION: The ventilating techniques, ventilators and face masks were the main factors influencing FMMV results. FMMV could be used rationally for most COPD patients with RF as a valuable alternative to ETMV.