Investigation of chronic cough in tropics:A cost effective analysis

• Main Authors: Nadri F, D′Souza G
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2007-01-01
• Series: Lung India
• Subjects: Chronic Cough: Asthma: Loeffler′s Syndrome: Postnasal Drip Syndrome: Pulmonary Tuberculosis: Gastroesophageal Reflux Disease.
• Online Access: http://www.lungindia.com/article.asp?issn=0970-2113;year=2007;volume=24;issue=1;spage=11;epage=16;aulast=Nadri

<b>Objectives:</b> To ascertain the validity of anatomic diagnostic protocol in determin-ing the etiology of chronic cough in tropics and a cost analysis of the protocol to ascertain effective ways of managing patients with chronic cough. <b>Methods:</b> A prospective, descriptive, study of non-smoking patients with chronic cough. All patients were evaluated by a validated anatomic diagnostic protocol. The diagnostic protocol was modified to include sputum examination for acid-fast bacilli, absolute eosinophil count and stool examination. The final diagnosis was based on radiological, laboratory findings and a successful response to therapy. <b>Results:</b> Eighty-seven consecutive patients with chronic cough were evaluated from February 2000 to February 2002 using the modified diagnostic protocol. The mean age &#x00B1;S.D. was 35.00&#x00B1;11.85 years. Forty-nine patients were males. Etiology of chronic cough was established in 86 (99&#x0025;) patients. Cough resolved in 99&#x0025; of patients after successful diagnosis and treatment. The three most common causes were Postnasal drip syndrome (PNDS), 52&#x0025;, Asthma, 41&#x0025;, and Loeffler&#x2032;s syn-drome, 8&#x0025;. Pulmonary tuberculosis was confirmed in 5&#x0025; of patients. Hence, 13&#x0025; of patients had conditions more prevalent in the tropics. Gastroesophageal reflux disease (GERD) was seen in 6&#x0025;. Rare causes of chronic cough included congestive cardiac failure (CCF) 2&#x0025;. Cough was due to multiple causes in 15&#x0025;. The average cost per patient was Rupees (RS) 878.55 (1US$=RS 45). However if we use the pro-tocol proposed at the end of study the average cost per patient will be RS 743.55. Using the modified diagnostic protocol 90&#x0025; of patients were diagnosed with mini-mal investigations making it cost effective. <b>Conclusion:</b> The three most common causes of chronic cough in the tropics are different from the west. Pulmonary tuberculosis and Loeffler&#x2032;s syndrome are more prevalent and need to be considered. Using a modified diagnostic protocol etiology of chronic cough can be determined successfully in tropical countries in most patients. A cost effective way of evaluating cough has been proposed.