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Diagnostic Performance of Routine Objective Tests and Cost-Effective Approach for Chronic Cough  

Jeon, Gang (Hallym University College of Medicine, Department of Internal Medicine)
Jang, Seung Hun (Hallym University College of Medicine, Department of Internal Medicine)
Song, Hae Geun (Hallym University College of Medicine, Department of Internal Medicine)
Ha, Jun-Wook (Hallym University College of Medicine, Department of Internal Medicine)
Eom, Kwang-Seok (Hallym University College of Medicine, Department of Internal Medicine)
Bahn, Joon-Woo (Hallym University College of Medicine, Department of Internal Medicine)
Kim, Dong-Gyu (Hallym University College of Medicine, Department of Internal Medicine)
Shin, Tae Rim (Hallym University College of Medicine, Department of Internal Medicine)
Park, Sang Myon (Hallym University College of Medicine, Department of Internal Medicine)
Park, Yong Bum (Hallym University College of Medicine, Department of Internal Medicine)
Kim, Chul-Hong (Hallym University College of Medicine, Department of Internal Medicine)
Hyun, In-Gyu (Hallym University College of Medicine, Department of Internal Medicine)
Jung, Ki-Suck (Hallym University College of Medicine, Department of Internal Medicine)
Publication Information
Tuberculosis and Respiratory Diseases / v.57, no.6, 2004 , pp. 535-542 More about this Journal
Abstract
Background : Despite the clinical clues of bronchial asthma, some chronic coughers fail to be diagnosed due to negative test results. This study was aimed at evaluating the diagnostic performance of routine objective tests and identifying a cost-effective approach for asthmatics with a chronic cough. Methods : Patients with a chronic cough of more than 3 weeks duration, and showing normal chest radiograph and spirometry were enrolled. On the first visit, objective tests, composed of serum total IgE, peripheral blood eosinophil count, spontaneous sputum eosinophil count, methacholine bronchial provocation test (MBPT) and paranasal sinus radiograph, were performed, with the simultaneous administration of oral prednisolone (0.5mg/kg) for one week. The final diagnoses were made on the basis of the test results, and the patients grouped according to their steroid responsiveness. The role of the etiologic diagnosis tests was evaluated, and the medical costs of the final management plan simulated with respect to three assumed models. Results : Sixty chronic coughers were finally analyzed. The final diagnoses were as follows: bronchial asthma 21.7%, eosinophilic bronchitis 6.7%, paranasal sinusitis 18.3%, presumptive allergy 8.3% and non-diagnostic case 45.0%. Ninety percent were steroid responder. With the bronchial asthma cases, the positive rate of MBPT was 38.5%, with sputum eosinophil count in 84.6%, serum total IgE in 38.5%, and a peripheral blood eosinophil count rate of 30.8%. When the test results and steroid responsiveness data were applied to the 3 models, the chest radiograph, spirometry, sputum eosinophil count and paranasal sinus radiograph test results, and simultaneous short term steroid treatment seemed to have acceptable diagnostic performances, which could be used as a further guide to cost-effective planning. Conclusion : Objective tests, composed of chest radiograph, spirometry, paranasal sinus radiograph and sputum eosinophil count, with simultaneous short term steroid treatment, are suggested as cost-effective approaches for asthmatics with a chronic cough.
Keywords
Chronic cough; Diagnostic performance; Cost-effective approach;
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1 Irwin RS, Rosen MJ, Braman SS. Cough. A conmre hensive review. Arch Intem Med 1977;137:1186 91
2 de Marco R, Cerveri I, Bugiani M, Feirari M, Verlato G. An undetected burden of asthma in Italy: the relationship between dinical and epidemiological dia gnosis of asthma. Eur Rispir J 1998;11:599-605
3 Youden WJ. Index for rating diagnostic tests. Cancer 1950;3:32-5
4 Briehaing CE, Ward R, Coh KL, Wardlaw AJ, Pavord ID. Eosinophilic bronchitis is an important cause of chronic coueh. Am J Respir Crit Care Med 1999;160:406 10
5 Kaur B, Andeison HR, Austin J, Bun. M, Haihms LS, Strachan DP, et al. Rreva1ence of asthma symptoms, diagnosis, and treatment in 12-14 year old children across Great BrItain (international study of asthma and allergies in chidhood, ISAAC UK) BMJ 1998;316 118-24
6 Lee SY, Cho JY, Shim JJ, Kim HK, Kang KH, Yoo SH, et al. Airway mflamrmtion as an assessment of chronic nonproductive coueh. Chest 2001;120:1114 20
7 Irwin RS, Curley FJ, Fhindi CL Chronic coueh. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific the rapy. Am Rev Respir Dis 1990;141:610 7
8 Irwin RS, Boulet LP, Cloulier MM, Fuller R, Gold PM, Hoffstein V, et al. Managing cough as a defense me chanism. and as a symptom. A oaisensus panel report of the American College of Chest Physicians. Chest 1998;114:133S-181S
9 Asthma study group in Korea, Korean Instititute for Health and Soeial Affairs. Rreva1ence of asthma like symptcans in Korean adult population. Korean J In temal Med 2001;60:196-205
10 Mello CJ, Irwin RS, Cudey FJ. Predictive values of the character, timmg, and complications of chronic cough in diagnsing ita cavse. Arch Intcrn Med 1996;156 997-1003
11 Irwin RS, Corrao WM, Pratter MR Chronic persistent cough- in the adult: the spectrum and freqLiency cf causes and successful outcome of specific therapy. Am Rev Respir Dis 1981; 123:413-7
12 Behbehani NA, Abal A, Syabbalo NC, Abd Azeem A, Shareef E, Al Momen J. Prevalence of asthma, allergic rhinitis, and eczema in 13 to 14-year-o1d diildren in Kuwait: an ISAAC study. Inbematicnal Study ofAsthma and Allergies in Childhood. Ann Allergy Asthma Immunol 2000;85:58-63
13 Irwin RS, Madison JM The diagnosis and treatment of cough. N Engl J Med 2000;343:1715 21