Chronic cough: differential diagnosis and treatment
https://doi.org/10.21518/2079-701X-2020-17-124-131
Abstract
Cough is one of the most common symptoms and is present in diseases of the respiratory, cardiovascular, digestive, endocrine and other systems. Cough is a reflex act, therefore it is caused by stimulation of cough receptors due to pathological influences. The diagnosis takes into account the nature of the cough, its duration, the results of laboratory and instrumental examination methods. The most attention is required to diagnose chronic cough and exclude life-threatening causes. Symptoms of anxiety are hemoptysis, prolonged resistant cough, prolonged intoxication syndrome, weight loss, etc. In diagnostically unclear cases, the examination schedule must include computed tomography of the chest, magnetic resonance imaging and bronchoscopy. A dry, painful intense cough can lead to the development of complications: a decrease in the quality of life, hemorrhages, pneumothorax, etc., therefore, requires symptomatic treatment. A common cause of unproductive cough is viral diseases, whooping cough, diseases leading to overactive cough receptors. The variety of coughs determines a differentiated approach to its therapy. The main efforts should be directed to the treatment of the underlying disease. In the case of a productive cough, mucoactive drugs are used. To stop unproductive cough, antitussive drugs of central and peripheral action are used. The recommendations of the European Respiratory Society present the results of clinical trials assessing the efficacy and safety of antitussive drugs with morphine-like action. The study identified side effects that limit their use. One of the most effective and safe drugs is a non-opioid drug with a central action Sinekod. The effectiveness and safety of the drug is confirmed by clinical studies.
About the Author
N. V. OrlovaRussian Federation
Natalia V. Orlova, Dr. of Sci. (Med.), Professor
1, Ostrovityanov St., Moscow, 117997
References
1. Irwin R.S., French C.T., Lewis S.Z., Diekemper R.L., Gold P.M. Expert Cough Pane Overview of the Management of Cough: CHEST Guideline and Expert Panel Report. Chest. 2014;146(4):885–889. doi: 10.1378/chest.14-1485.
2. Dicpinigaitis P.V., Morice A.H., Birring S.S., McGarvey L., Smith J.A., Canning B.J., Page C.P. Antitussive drugs – past, present, and future. Pharmacol Rev. 2014;66(2):468–512. doi: 10.1124/pr.111.005116.
3. Grace M., Birrell M.A., Dubuis E., Maher S.A., Belvisi M.G. Transient receptor potential channels mediate the tussive response to prostaglandin E2 and bradykinin. Thorax. 2012;67:891–900. doi: 10.1136/thoraxjnl-2011-201443.
4. Canning B.J., Chang A.B., Bolser D.C., Smith J.A., Mazzone S.B., McGarvey L. Anatomy and Neurophysiology of Cough. Chest. 2014;146(6):1633–1648. doi: 10.1378/chest.14-1481.
5. Shields M.D., Bush A., Everard M.L., McKenzie S., Primhak R. BTS guidelines: Recommendations for the assessment and management of cough in children. Thorax. 2008;63(Suppl. 3):iii1-iii15. doi: 10.1136/thx.2007.077370.
6. Morice A., Kardos P. Comprehensive evidence-based review on European antitussives. BMJ Open Respir Res. 2016;3(1):e000137. doi: 10.1136/bmjresp-2016-000137.
7. Paules C.I., Marston H.D., Fauci A.S. Coronavirus infections – more than just the common cold. JAMA. 2020;323(8):707–708. doi: 10.1001/jama.2020.0757.
8. Lu R., Zhao X., Li J., Niu P., Yang B., Wu H. et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565–574. doi: 10.1016/S0140-6736(20)30251-8.
9. Guan W.J., Ni Z.Y., Hu Y., Liang W.H., Ou C.Q., He J.X. et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708– 1720. Available at: https://www.nejm.org/doi/full/10.1056/nejmoa2002032.
10. The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020. China CDC Weekly. 2020;2(8):113–122. doi: 10.46234/ccdcw2020.032.
11. Wu C., Chen X., Cai Y., Xia J., Zhou X., Xu S. et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934–943. doi: 10.1001/jamainternmed.2020.0994.
12. Mao L., Wang M., Chen S., Quanwei He., Chang J., Hong C. et al. Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: A Retrospective Case Series Study. medRxiv. 2020. doi: 10.1101/2020.02.22.20026500.
13. Gu J., Han B., Wang J. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology. 158(6):1518–1519. doi: 10.1053/j.gastro.2020.02.054.
14. Xu Z., Shi L., Wang Y., Zhang J., Huang L., Zhang C. et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420–422. doi: 10.1016/S2213-2600(20)30076-X.
15. Guan W.J., Ni Z.Y., Hu Y., Liang W.H., Ou C.Q., He J.X. et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708–1720. doi: 10.1056/NEJMoa2002032.
16. Avdeyev S.N., Adamyan L.V., Baranov A.A., Baranova N.N., Briko N.I., Vasilyeva I.A. et al. Prevention, diagnosis and treatment of new coronavirus infection (2019-nCoV). Temporary guidelines. Version 7. Moscow; 2020. 166 p. (In Russ.) Available at: http://profilaktika.su/vremennye-metodicheskierekomendatsii-koronavirus-2019-ncov/.
17. Nikiforov V.V., Suranova T.G., Chernobrovkina T.Yu., Yankovskaya Y.D., Burova S.V. New Coronavirus Infection (Covid-19): Clinical and Epidemiological Aspects. Arkhiv vnutrenney meditsiny = The Russian Archives of Internal Medicine. 2020;10(2):87–93. (In Russ.) doi: 10.20514/2226-6704-2020-10-2-87-93.
18. Nikiforov V.V., Kolobukhina L.V., Smetanina S.V., Mazankova L.N., Plavunov N.F., Shchelkanov M.Yu. et al. New coronavirus infection (COVID-19): etiology, epidemiology, clinic, diagnosis, treatment and prevention. Moscow; 2020. 71 p. (In Russ.) Available at: https://www.biosoil.ru/Research/Publication/19048.
19. Gedik A., Çakir E., Torun E., Demir A., Kuçukkoc M., Erenberk U. et al. Evaluation of 563 children with chronic cough accompanied by a new clinical algorithm. Ital J Pediatr. 2015;41:73. doi: 10.1186/s13052-015-0180-0.
20. Karabel M., Kelekçi S., Karabel D., Gürkan M.F. The evaluation of children with prolonged cough accompanied by American College of Chest Physicians guidelines. Clin Respir J. 2014;8(2):152–159. doi: 10.1111/crj.12052.
21. Deng H.Y., Luo W., Zhang M., Xie J.X., Fang Z.Y., Lai K.F. Initial empirical treatment based on clinical feature of chronic cough. Clin Respir J. 2016;10(5):622–630. doi: 10.1111/crj.12270.
22. Lightdale J.R., Gremse D.A. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics. 2013;131(5): e1684–e1695. doi: 10.1542/peds.2013-0421.
23. Birring S.S., Kavanagh J., Lai K., Chang A.B. Adult and paediatric cough guidelines: Ready for an overhaul? Pulm Pharmacol Ther. 2015;35:137–144. doi: 10.1016/j.pupt.2015.01.007.
24. Morice A.H., Millqvist E., Bieksiene K., Birring S.S., Dicpinigaitis P., Domingo Ribas C. et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J. 2020;55(1):1901136. doi: 10.1183/13993003.01136-2019.
25. Chung K.F., Canning B., McGarvey L. Eight International London Cough Symposium 2014: Cough hypersensitivity syndrome as the basis for chronic cough. Pulm Pharmacol Ther. 2015;35:76–80. doi: 10.1016/j.pupt.2015.08.009.
26. Chung K.F., McGarvey L., Mazzone S.B. Chronic cough as a neuropathic disorder. Lancet Respir Med. 2013;1(5):414–422. doi: 10.1016/S2213-2600(13)70043-2.
27. Gibson P.G., Chang A.B., Glasgow N.J., Holmes P.W., Katelaris P., Kemp A.S. et al. CICADA: Cough in Children and Adults: Diagnosis and Assessment. Australian cough guidelines summary statement. Med J Aust. 2010;192(5):265–271. Available at: https://pubmed.ncbi.nlm.nih.gov/20201760.
28. Morice A.H. Epidemiology of cough. Pulm Pharmacol Ther. 2002;15(3):253– 259. doi: 10.1006/pupt.2002.0352.
29. Krajnik M., Damps-Konstanska I., Gorska L., Jassem E. A portable automatic cough analyser in the ambulatory assessment of cough. Biomed Eng Online. 2010;9:17. doi: 10.1186/1475-925X-9-17.
30. Spinou A., Birring S.S. An update on measurement and monitoring of cough: what are the important study endpoints? J Thorac Dis. 2014;6(Suppl 7):S728–S734. doi: 10.3978/j.issn.2072-1439.2014.10.08.
31. Morice A.H., Menon M.S., Mulrennan S.A., Everett C.F., Wright C., Jackson J., Thompson R. Opiate therapy in chronic cough. Am J Respir Crit Care Med. 2007;175(4):312–315. doi: 10.1164/rccm.200607-892OC.
32. Ryan N.M., Birring S.S., Gibson P.G. Gabapentin for refractory chronic cough: a randomised, double-blind, placebo-controlled trial. Lancet. 2012;380(9853):1583–1589. doi: 10.1016/S0140-6736(12)60776-4.
33. Vertigan A.E., Kapela S.L., Ryan N.M., Birring S.S., McElduff P., Gibson P.G. Pregabalin and speech pathology combination therapy for refractory chronic cough: a randomized controlled trial. Chest. 2016;149(3):639–648. doi: 10.1378/chest.15-1271.
34. Zaccara G., Giovannelli F., Giorgi F., Franco V., Gasparini S., Benedetto U. Tolerability of new antiepileptic drugs: a network meta-analysis. Eur J Clin Pharmacol. 2017;73(7):811–817. doi: 10.1007/s00228-017-2245-z.
35. Gardiner S.J., Chang A.B., Marchant J.M., Petsky H.L. Codeine versus placebo for chronic cough in children. Cochrane Database Syst Rev. 2016;7(7):CD011914. doi: 10.1002/14651858.CD011914.pub2.
36. Dvoretskiy L.I., Didkovskiy N.A. Coughing patient. Сonsilium Medicum. 2003;5(10):552–557. (In Russ.) Available at: http://old.consilium-medicum.com/media/consilium/03_10/552.shtml.
37. Orlova N.V. Management of cough in the review of current guidelines. Meditsinskiy sovet = Medical Council. 2019;(6):74–81. (In Russ.) doi: 10.21518/2079-701X-2019-6-74-81.
38. Kolosova N.G., Shatalina S.I. Antitussive drugs in the practice of a pediatrician. Meditsinskiy sovet = Medical Council. 2017;(9):76–80. (In Russ.) doi: 10.21518/2079-701X-2017-9-76-79.
39. Nikiforova G.N. Sinecod ® is the drug of choice for the treatment of dry cough in children and adults. RMZH = RMJ. 2011;(23):1436. (In Russ.) Available at: https://www.rmj.ru/articles/bolezni_dykhatelnykh_putey/Sinekod__preparat_vybora_dlya_lecheniya_suhogo_kashlya_u_detey_i_vzroslyh.
40. Miko P. The use and safety of butamirate containing drops, syrup and depot tablets in Hungary. Orv Hetil. 2005;146(13):609–612. Available at: https://pubmed.ncbi.nlm.nih.gov/15856625.
41. Płusa T. Butamirate citrate in control of cough in respiratory tract inflammation Pol Merkur Lekarski. 2017;43(254):69–74. Available at: https://pubmed.ncbi.nlm.nih.gov/28875973/.
42. Ryabova M.A. Cough: the view of an otorhinolaryngologist. Lechashchiy vrach. 2012;(9):19–25. (In Russ.) Available at: https://www.lvrach.ru/2012/09/15435523.
43. Blaiss M.S., Dicpinigaitis P.V., Eccles R., Wingertzahn M.A. Consumer attitudes on cough and cold: US (ACHOO) survey results. Curr Med Res Opin. 2015;31(8):1527–1538. doi: 10.1185/03007995.2014.1002558.
44. Klyachkina I.L. Choice of medications for a productive cough. Diseases of the respiratory system. Consilium Medicum. 2007;(1):8–13. (In Russ.) Available at: http://old.consilium-medicum.com/media/pulmo/07_01/8.shtml.
45. Braga P.C., Allegra L.C. (eds.). Drugs in Bronchial Mucology. New York: Raven Press; 1989. 368 p. doi: 10.1164/ajrccm/140.4.1172.
Review
For citations:
Orlova NV. Chronic cough: differential diagnosis and treatment. Meditsinskiy sovet = Medical Council. 2020;(17):124-131. (In Russ.) https://doi.org/10.21518/2079-701X-2020-17-124-131