Clinical benefit of sequential three-step empirical therapy in the management of chronic cough.

Abstract

BACKGROUND AND OBJECTIVE:

A prospective study was conducted to investigate the efficacy of empirical therapy in the management of chronic cough.

METHODS:

A three-step empirical therapy protocol was used to treat patients who had a chronic cough and a normal CXR and normal lung function testing. In step one antihistamine decongestants plus bronchodilators were taken, corticosteroids in the second step, and a combination of a proton pump inhibitor and a prokinetic agent in the third step. Cough symptom scores were recorded before and after each step in the protocol.

RESULTS:

There were 102 patients recruited; mean age 49 +/- 16 years and with a history of cough of between 2 and 120 months at presentation. The cough resolved in 67.6% (n = 69) of the patients after the first-step therapy; in a further 12.7% (13) after the second-step therapy, and in another 7.8% (8) after the third-step of the treatment protocol. In three patients cough improved after the first-step of therapy but only achieved complete resolution when this treatment was combined with the third-step therapy. Overall, the three-step empirical therapy was successful in 88.2% (n = 90) of the patients. Cough symptom scores decreased from 3.30 +/- 0.75 to 0.30 +/- 0.97 (P < 0.001). The mean duration of treatment was 2.70 +/- 1.52 weeks (range 1-12). Cough was controlled in <4 weeks in 79.4% (n = 81) of patients.

CONCLUSIONS:

Three-step empirical therapy seemed to be useful in most patients and has practical application in the management of chronic cough.

• Authors: Li Yu, Zhongmin Qiu, Hanjing Lü, Weili Wei, Cuiqin Shi
• Journal: Respirology (Carlton, Vic.) (Respirology) Vol. 13 Issue 3 Pg. 353-8 (May 2008) ISSN: 1440-1843 [Electronic] Australia
• PMID: 18399856 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenal Cortex Hormones
• Bronchodilator Agents
• Histamine H1 Antagonists
• Proton Pump Inhibitors

Topics

• Adolescent
• Adrenal Cortex Hormones (adverse effects, therapeutic use)
• Adult
• Aged
• Aged, 80 and over
• Bronchodilator Agents (adverse effects, therapeutic use)
• Chronic Disease
• Cough (drug therapy, physiopathology)
• Drug Therapy, Combination
• Empirical Research
• Female
• Forced Expiratory Volume (drug effects, physiology)
• Histamine H1 Antagonists (adverse effects, therapeutic use)
• Humans
• Male
• Middle Aged
• Prospective Studies
• Proton Pump Inhibitors (adverse effects, therapeutic use)
• Treatment Outcome