1 / 39

CHRONIC COUGH rhinitis-postnasal drip syndrome “Upper airway cough syndrome” Sevim Bavbek, M.D. Ankara University, Schoo

CHRONIC COUGH rhinitis-postnasal drip syndrome “Upper airway cough syndrome” Sevim Bavbek, M.D. Ankara University, School of Medicine Department of Allergy. Cases Introduction-definition Prevalence Pathogenesis Diagnosis-Diferential diagnosis Treatment. Case-1.

liuz
Download Presentation

CHRONIC COUGH rhinitis-postnasal drip syndrome “Upper airway cough syndrome” Sevim Bavbek, M.D. Ankara University, Schoo

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CHRONIC COUGHrhinitis-postnasal dripsyndrome“Upper airway cough syndrome”Sevim Bavbek, M.D.Ankara University, School of MedicineDepartment of Allergy

  2. Cases • Introduction-definition • Prevalence • Pathogenesis • Diagnosis-Diferential diagnosis • Treatment

  3. Case-1 • 21 year-old, female, university student • She has been suffering sneezing, nasal discharge, itching in eyes, nose and ears for 3 years during pollen season • She has been couging for a month • Management?

  4. Case-2 • 28 years-old, dentist • She has been suffering dry cough for 2 months • Some difficulties in her work and family relationship • Operation for sinusitis has been suggested a year ago • On nasal steroid, oral antihistamine/deconjestant • Management?

  5. Problems • Syndrome? • Symptom? • Lack of objective testing • “Wastebasket” symptom complex? • American invention? • Upper airway cough syndrome

  6. PND Allergic rhinitis Chronic sinusitis GERD/LPR Cough-variant asthma ACE Inhibitor medications Pertussis (whooping cough) Neurogenic Traumatic vagal injury Post-URI neuropathy Psychogenic Chronic aspiration Zenker’s diverticulum Foreign body Tracheobronchial tree Laryngopharynx Sinonasal External auditory canal Chronic bronchitis Bronchiectasis Lung carcinoma Subglottic stenosis Tracheomalacia Tracheoesophageal fistula Tuberculosis Sarcoidosis Congestive heart failure Differential diagnosis for cough in an adult URI, upper-respiratory infection. Simpson CB. et al. Otolaryngology–Head Neck Surg 2006; 134: 693-700

  7. Percentage of cases presenting one, two, three and four causative factors Palombini BC et al. Chest 1999; 116: 2

  8. Comparison of the results of four studies about the most common single causes of chronic cough. % of patients Palombini BC et al. Chest 1999; 116: 2

  9. Commonest causes of chronic cough in patients investigated in specialist clinics Morice AH. Eur Respir J 2004; 24: 481–492

  10. Etiologic factors of chronic cough in the patients, distributed as the pathogenic triad of chronic cough PNDS ASTHMA GERD Palombini BC et al. Chest 1999; 116: 2

  11. Overlap between diagnostic abnormalities in patients with chronic cough SCL-90 PNDS EOS BHR Carney IK et al. Am Rev Respir Crit Care Med 1997;156:211-16

  12. Relationship between bronchial and EA responsiveness during exacerbation of sinusitis 1.8 1.5 1.2 0.9 0.6 0.3 0 -0.3 -0.6 r=0.75 p<0.001 PC25 MIF50 log(mg/ml) -0.6 -0.3 0 0.3 0.6 0.9 1.2 1.5 1.8 PC20 FEV1 log(mg/ml) Bucca C et al. J Allergy Clın Immunol 1995;95.'52-9

  13. Location of cough receptors and associated sensory nerve *Greatest concentration of cough receptors.

  14. Potential actions of and interactions between the vagal afferent nerves mediating cough Canning BJ. et al. Chest 2006; 129:33S–47S

  15. History Cough Post nasal drip Tickle in the throat Frequent throat cleaning Nasal congestion, discharge Hoarseness Silent Physical exam Mucoid/muco-purulent secretions Cobblesto appearance Upper airway cough syndrome

  16. Upper airway cough syndrome • diagnosis history physical exam laboratory treatment

  17. Upper airway cough syndrome • Differential diagnosis • Allergic rhinitis • Nonallergic rhinitis • Post-infectious UACS • NARES • Bacterial sinusitis • Allergic fungal sinusitis • Rhinitis due to anatomical abnormalities • Rhinitis due to physical or chemical irritants • Occupational rhinitis • Rhinitis medicamentoza • Gestational rhinitis

  18. Cough counts/hour in healthy controls and patients with chronic cough 150 125 100 75 50 25 0 Coughs/hour p<0.001 Normal Chronic cough Birring SS et al., Respir Med 2005;9(23)

  19. Complications of Cough-1 Irwin RS. Chest 2006; 129:54S–58S

  20. Complications of Cough-2 Irwin RS. Chest 2006; 129:54S–58S

  21. Complications of Cough-3 Irwin RS. Chest 2006; 129:54S–58S

  22. Spectrum and frequency of reasons why patients with chronic cough sough medical care* * N= 39. The relative frequencies for the 28 patients used in the major analyses of this study were similar. AIDS indicates acquired immunodeficieny syndrome; TB: tuberculosis. French CL. Arch Intern Med 158(10): 1657-1661, 1998

  23. Total Physical Psychosocial Ambulation * Mobility Body Care and Movement Social Interaction * Communication Alertness Behavior Emotional Behavior Sleep and Rest * Eating Work * Home Management * Recreation and Pastimes * 0 10 20 30 40 SIP Score, % Sickness Impact Profile (SIP) scores at baseline in patient with chronic cough French CL. Arch Intern Med 158(10): 1657-1661, 1998

  24. Sickness Impact Profile (SIP) scores before and after successful treatment of chronic cough at baseline in patient with chronic cough p=.003 p<.02 6 4 2 0 6 4 2 0 6 4 2 0 p=.05 Physical Score, % Total SIP Score, % Physicososyal Score, % Before After Before After Before After Treatment Treatment Treatment French CL. Arch Intern Med 158(10): 1657-1661, 1998

  25. Symptoms of allergic rhinitis C.van Drunen et al. Allergy 2005;60:5-19

  26. Treatment of allergic rhiitis

  27. Treatment • Antihistamins • Steroids • Mast cell stabilizators • Decongestans • Antihistaminik ve dekonjestan kombinasyonu • Anticholinerjics • Leucotriene antagonists

  28. Nonallergic rhinitis: NARES • Nasal symptoms similar to those of vasomotor rhinitis • Additionally, pruritus of nasal and ocular mucosae and lacrimation are common • Clinical findings • Eosinophils in nasal secretions DIAGNOSIS • Nasal cs. TREATMENT Pratter MR. Chest 2006; 129:63S-71S

  29. Nonallergic rhinitis: Vasomotor rhinitis • Excessive,thin watery secretions often in reponse to odors, changes in temperature or humidity, eating, or alcohol ingestion • DIAGNOSIS: History and exclusion of other diseases • TREATMENT: Ipratropium bromide

  30. Postinfectious UACS • Persistent cough lasting >3 weeks after experiencing the acute symptoms of an upper respiratory tract infection • DIAGNOSIS: A history of a upper respiratory tract infection • TREATMENT: Antihistamine/decongestant combination Systemic cs? Ipratropium bromide?

  31. Symptoms of rhinosinusitis xxxxxxxxxxxxxxxxx

  32. Symptoms suggestive of chronic sinusitis • Initial evaluation • History • Physical examination • Consider sinus CT and/or nasal endoscopy • Evaluate underlying risk factors • Consider consultation with a specialist for evaluation underlying risk factors • Treatment • Antibiotics • Antiinflammatory and/or decongestant therapy Refractory Chronic Sinusitis • Consider non-infectious hyperplastic eosinophilic sinusitis • Consider consultation with a surgeon • Continued individualized medical therapy Sinusitis Update Workgroup. JACI 2005;116:S13-47

  33. Allergic Aspergillus sinusitis

  34. Diagnosis • Radiological evaluation • Histopathological evaluation • Nasal lavage evaluation • Serolojik testings Shah a. ACII 2005;17(5):172-180

  35. Therapeutic suggestions for allergic fungal sinusitis • Prednisone and topical intranasal corticosteroid • Sinus irrigation if necessary • Follow-up CT scans of sinuses • After 8 weeks, discontinue prednisone and continue topical corticosteroids Greenburger PA. Allergic bronchopulmoner aspergillosis 1995; p:53-55

  36. Case-1 • Skin prick test: Highly pozitif for grass pollen • Pulmonary function testing: Normal • Treatment: Nasal steroid and antihistamine

  37. Case-2 • Skin prick test: Negatif • Pulmonary function testing: Normal • Bronchial provocation test Methacholine Pc20: 2.3 mg/ml • Treatment: inhaled steroid+sinus surgery

  38. Conclusions • Upper airway cough syndrome seems to be more accurate (UACS) • The diagnosis should be determined by a combination of symptoms, physical examination findings, radiographic findings, and response to specific therapy • Specific treatment should be directed at the cause of cough • Empiric therapy for UACS with 1st generation antihistamine/decongestan should be prescribed before extensive diagnostic workup. Pratter MR. Chest 2006; 129:63S-71S

More Related