In a later study by Irwin and associates, 12 the sensitivity of prolonged esophageal monitoring was only 92 percent thus, although it is the best study for diagnosing GERD, it is not a “gold standard.” The finding with the best predictive value was that of acid reflux events associated with cough episodes. Positive prolonged esophageal monitoring was the only means of diagnosis in nine patients (23 percent) diagnosed with GERD. Prolonged esophageal monitoring was positive in 100 percent of 20 patients in whom it was obtained and, based on response to therapy, no false-positive results occurred. A positive methacholine inhalation challenge test was the only means of diagnosis in nine patients (28 percent of 32 asthmatic patients with no other symptoms or signs and normal baseline spirometry). However, on the basis of whether specific therapy eliminated the cough as a complaint, the tests were determined to have a false-positive rate and positive predictive value as noted in Table 4. Irwin and colleagues 8 found that all of the tests used in their study of the work-up of cough had a sensitivity of 100 percent (no false negatives, resulting in a negative predictive value of 100 percent), except for the barium swallow examination. For the minority of patients in whom this diagnostic approach is unsuccessful, consultation with a pulmonary specialist is appropriate. However, in some cases it may take three to five months to determine a diagnosis and effective treatment. By using a standard protocol for diagnosis and treatment, 90 percent of patients with chronic cough can be managed successfully in the family physician's office. If a therapeutic trial is not successful, sequential diagnostic testing including chest radiograph, purified protein derivative test for tuberculosis, computed tomography of the sinuses, methacholine challenge test or barium swallow may be indicated. The initial treatment of patients with cough is often empiric and may involve a trial of decongestants, bronchodilators or histamine H 2 antagonists, as monotherapy or in combination. The three most common causes of chronic cough in those who are referred to pulmonary specialists are postnasal drip, asthma and gastroesophageal reflux. Treating nocturia symptoms typically involves restricting fluid intake and the. Nocturia may be caused by an overactive bladder, sleep apnea, or other factors like lifestyle and health conditions. In cases of nocturnal polyuria, up to of urine output happens overnight. However, still, more information is needed regarding cause-effect relationships and longitudinal trends of nocturnal cough in asthma.Ĭopyright © 2023, StatPearls Publishing LLC.Chronic cough is a common problem in patients who visit family physicians. To hand over or relinquish (money or another possession), often reluctantly. Nocturia is a condition that causes you to wake up at night to urinate. Marsden et al reported that the parameter of nocturnal cough could be a valid indicator for asthma control. In asthma, symptoms usually worsen at night and cause awakenings affecting the quality of life. This cough reflex has neuroplasticity in such a way that hypersensitive response is triggered over time because of the cough itself causing chronic irritation and inflammation and leading to tissue remodeling.Īsthma is a highly prevalent chronic respiratory disease with nocturnal cough as one of the presenting features. Nocturnal cough is distressing and may cause disturbances in sleep. Women tend to have a chronic cough more often and have heightened cough reflex sensitivity compared to men. Impairment or absence of the coughing mechanism can be dangerous and even fatal in disease. A cough is a symptom and a reflex action that is an essential protective and defensive act that secures the removal of mucus, noxious substances, and infections from the larynx, trachea, and larger bronchi.
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