Chronic cough related to the upper airway cough syndrome: one entity but not always the same.

PURPOSE: Upper airway cough syndrome (UACS), described as chronic cough (CC) associated with allergic (AR), non-allergic rhinitis (NAR) or chronic rhinosinusitis (CRS), is one of the major causes of CC. We aimed to characterize a cohort of UACS patients with special attention to differences between patients with AR and NAR. METHODS: A prospective analysis of clinical data of patients, diagnosed with UACS between 2015 and 2018. RESULTS: There were 143 patients diagnosed with UACS, median age 52 years, women predominance (68.5%), The group comprised of 59 (41%) AR and 84 (59%) NAR subjects, CRS diagnosed in 17 (12%). Median cough duration: 48 months (IQR 24-120), median cough severity (VAS)-60 mm (IQR 42-78), median Leicester Cough Questionnaire (LCQ) score-11.3 (IQR 8.7-13.7), never-smokers: 70%. The most common symptoms: PND (62%), rhinorrhea (59%), nasal congestion (54%), abnormalities of sinus CT: septum deviation (62%), turbinates hypertrophy (53%), mucosal thickening (53%). UACS as the only cause of CC, was presented in 20 patients (14%). We found no differences between patients with AR and NAR in terms of age, gender, duration and severity of cough, BMI, blood eosinophil count, total IgE and FeNO. AR was associated with higher comorbidity of asthma than NAR (54% vs 35%, p = 0.019). Abnormalities in sinus CT scan were more frequently found in patients with NAR than AR (p = 0.018). CONCLUSION: NAR is the most common upper airway disease associated with UACS. Clinical characteristics of UACS patients with AR and NAR are similar with only minor differences between these groups. It seems reasonable to plan further studies concerning relationship of NAR and cough sensitivity, also in terms of potential similar neurogenic mechanism.

Speech therapy in the management of difficult-to-treat chronic cough - preliminary results.

INTRODUCTION: The efficacy of management of chronic cough in adults is limited. Speech therapy is one of the few therapeutic methods which seems to be useful in patients with persistent chronic cough. However, the method has not been available in Poland so far. The aim of the study was to implement speech therapy and assess its efficacy in the management of patients with difficult-to-treat chronic cough. MATERIAL AND METHODS: Patients, who were diagnosed and managed due to difficult-to-treat chronic cough, were enrolled into the study. Speech therapy was developed on the basis of the technique described by Vertigan. The entire therapy consisted of eight weekly sessions, each lasting 45 minutes. Before and after speech therapy, cough severity and its impact on the quality of life was assessed by the Visual Analogue Scale (VAS) and Leicester Cough Questionnaire (LCQ). Additionally, cough challenge test with capsaicin was performed. RESULTS: Eighteen women were enrolled into the study, 15 of them (83%) attended all treatment sessions (median age 66 years, median duration of cough 60 months). There was a significant decrease in cough severity measured by VAS (46 vs 28 mm, p = 0.016) after completion of speech therapy. A significant improvement in patients' quality of life measured by LCQ (10.7 vs 14.6 points, p = 0.004) and an increase in the threshold of cough reflex measured by capsaicin challenge were also demonstrated. CONCLUSIONS: Speech therapy resulted in a decrease in cough severity and improvement of quality of life of females with refractory chronic cough. Our results support the use of speech therapy as add-on treatment in females with difficult-to-treat cough.

Is a normal chest radiograph sufficient to exclude pulmonary abnormalities potentially associated with chronic cough?

INTRODUCTION: There are few original studies on the true role of normal chest radiograph (CXR) in exclusion of pulmonary conditions that may be associated with chronic cough. Thus, the aim of the study was to assess whether a plain CXR is a sufficient tool to exclude relevant pulmonary causes of chronic cough. MATERIAL AND METHODS: A retrospective analysis of chest computed tomography (CT) scans in non-smoking patients with chronic cough and normal CXR was performed. The percentage of individuals in whom chest CT revealed relevant abnormalities was compared with the percentage of patients with irrelevant findings or normal chest CT scans. The negative predictive value (NPV) of the CXR in diagnosing the causes of chronic cough was calculated as a proportion of true negative CXRs (normal CXR AND irrelevant CT findings OR normal CT scan) to all negative CXRs (all patients, who had both a CXR and CT scan). RESULTS: The study group consisted of 59 adult patients with chronic cough, normal CXR and CT scan performed to diagnose the cause of chronic cough. In 21 patients (21/59, 36%), chest CT revealed abnormalities that were classified as relevant to chronic cough. The most frequent were: bronchiectasis (7/59, 11.9%), bronchial wall thickening (6/59, 10.2%) and mediastinal lymphadenopathy (5/59, 8.5%). The NPV of a CXR in diagnosing the causes of chronic cough was 64%. CONCLUSIONS: In conclusion, the NPV of CXR in diagnosing pulmonary causes of chronic cough is relatively low. Thus, plain CXR seems to be insufficient to exclude pulmonary diseases potentially associated with chronic cough.

Validation of the Polish Version of the Chronic Cough Quality of Life Questionnaire (Leicester Cough Questionnaire).

BACKGROUND: The Leicester Cough Questionnaire (LCQ) is one of the few specific quality-of-life questionnaires (QOLQ) dedicated to measuring the impact of chronic cough on patients' health/condition. OBJECTIVES: The aim of the study was to validate the Polish version of the LCQ. MATERIAL AND METHODS: The LCQ was translated forward and backward. The Polish version of the LCQ was tested on 35 patients suffering from chronic cough (23 women, median age 60 years, nonor ex-smokers, median cough duration of 23 weeks). Its validity was tested by comparison to a visual analogue scale (VAS) of cough intensity and other health questionnaires (hospital anxiety and depression scale - HADS, Euro-Quality of Life Questionnaire - EQ5D, St. George's Respiratory Questionnaire - SGRQ). The internal reliability of the Polish version of the LCQ was determined using the Cronbach alpha coefficient and its repeatability by the intraclass consistency coefficient. RESULTS: The translation of the LCQ into Polish was accepted by the author of the original LCQ. The Cronbach's alpha coefficient for total LCQ was 0.89, and reached 0.82, 0.86 and 0.78 for the physical, psychological and social domain, respectively. There were significant negative correlations between cough severity measured by VAS, the results of the EQ5D and SGRQ and the Polish version of the LCQ. The intraclass correlation coefficient of the test-retest reliability was significant (0.99). CONCLUSIONS: The Polish version of the LCQ has been validated and is a reliable tool to measure the impact of chronic cough on quality of life of patients with chronic cough.

The utility of oesophageal pH monitoring in diagnosing gastroesophageal reflux disease-related chronic cough.

INTRODUCTION: Chronic cough is a common medical complaint, which may deteriorate patients' quality of life and cause many complications. Gastroesophageal reflux disease (GERD) is one of the frequent reasons for chronic cough. Oesophageal pH monitoring is one of the diagnostic methods performed to confirm diagnosis of GERD-related cough. The aim of the study was to analyse the utility of oesophageal pH monitoring in diagnosing GERD-related cough and to identify the most sensitive pH monitoring parameters for diagnosing GERD-related cough. MATERIAL AND METHODS: 24-hour oesophageal pH monitoring was performed in 204 patients suffering from chronic cough. The group consisted of 65% females and the median age was 59 years. An acid reflux episode was defined as a rapid drop in pH to a value below 4 for at least 12 seconds. The diagnosis of GERD was based on total fraction time of pH < 4, upright or supine fraction time of pH < 4, or DeMeester score. The diagnosis of GERD-related cough was made if cough episodes, marked by the patients, appeared within 2 minutes after the reflux. The association between reflux episode and appearance of cough was analysed using two parameters: symptom index (SI ≥ 50%) and/or symptom association probability (SAP ≥ 95%). RESULTS: Based on results of pH monitoring, 135 patients (135/204, 66%) were diagnosed with GERD. Among them, 117 patients (117/135, 87%) were diagnosed based on DeMeester score. Among patients with GERD, 61 patients met the criteria of GERD-related cough (61/135, 45%), i.e. 30% of the group as a whole. Thirty-six patients (36/61, 59%) were diagnosed based on SAP, 12 patients (20%) based on SI, and 13 (21%) based on both parameters. Spearman rank correlation coefficient for SAP ≥ 95% and SI ≥ 50% was 0.46 (p < 0.05). CONCLUSIONS: Based on pH monitoring results, GERD was diagnosed twice as often as GERD-related cough. SAP index is more sensitive than SI for the diagnosis of GERD-related cough.