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Background: Cough is one of the most common complaints, for which patients seek medical attention. Health-care expenditure for managing cough is substantial with which quality of life can be severely affected. This study was conducted to analyze the clinical and radiological characteristics of common causes of chronic cough. Materials and Methods: This is a cross-sectional study conducted in the Department of Tuberculosis and Respiratory Medicine in GSL General Hospital during the period of October 1, 2016-June 30, 2018. Socio-demographic variables and clinical and laboratory parameters were collected and analyzed. Results: Among the 241 study participants, 68.9% were males. About 90% belong to low socioeconomic class, 56% were daily labourers, and 76.3% of them used biomass fuel for cooking. Other symptoms such as fever, chest pain, and shortness of breath were found along with cough. About 43.1% had other comorbidities. Normal chest X-ray is seen in 28%, non-cavitating lesions 22%, consolidation in 10%, emphysematous changes in 10%, bronchiectasis changes in 6%, mass lesion in 3%, interstitial pattern in 2%, pleural effusion in 0.6%, and cavity with air-fluid level in 0.4%. Sputum is negative for acid-fast bacilli in 51.5% of the study population. Pulmonary function tests were normal in 32%, which showed mild, moderate, severe obstruction in 24%, 17%, and 11%, respectively, while restriction in only 2% of the cases. Among 241, 49% diagnosed as pulmonary tuberculosis, 22% as chronic obstructive pulmonary disease, 11% were bronchiectasis, 7% were bronchial asthma, 7% were carcinoma, 3% were interstitial lung diseases, 3% were bronchitis, 1% gastroesophageal reflux disease, and 0.4% lung abscess. Conclusion: The treatment of chronic cough should include a systematic step-wise approach to diagnose the cause of cough. Timely management of the disease should be done effectively to decrease the disease burden. [ABSTRACT FROM AUTHOR]

Objective: To investigate patterns of presentation of cough in primary care and develop an algorithm to identify probable and possible chronic cough (CC).Methods: This retrospective observational study used routine English primary care data and linked hospital data. Patients with ≥1 cough event in the study period (March 2014-February 2015) were selected. Index date was that of the earliest cough event in this period. Adults (aged ≥18 years) were classified as having probable CC if they had an explicit CC diagnosis; as having possible CC if they had ≥3 cough events recorded over 8-26 weeks; or, otherwise, as having acute cough. Underlying conditions associated with CC were identified.Results: 198,151 people were identified. 56.5% were female; median age was 47.0 years. The prevalence of cough in the study year was 17.6%. Of the 150,213 identified adults, 1600 (1.1%), 10,913 (7.3%) and 137,718 (91.7%) were classified as having probable CC, possible CC or acute cough, respectively. Compared with probable CC and acute cough, a higher percentage of possible CC cases had a record on or prior to index date indicative of chronic obstructive pulmonary disease (30.6% versus 10.1% and 9.7%), gastro-esophageal reflux disease (32.6% versus 24.9% and 21.1%) or asthma (45.9% versus 27.6% and 27.9%). Prevalences of probable and possible CC were 0.18% and 1.2%, respectively.Conclusions: The prevalence of CC was lower than reported in previous studies. People with possible CC had higher rates of underlying conditions associated with CC. These observations may suggest poor recognition and/or under-recording of CC in primary care. [ABSTRACT FROM AUTHOR]

Background: In this study, we investigated the relationship between chronic cough and clinicopathological features in postoperative patients with non‐small cell lung cancer (NSCLC) and evaluated the effectiveness of acupuncture therapy for the treatment of postoperative chronic cough in patients with NSCLC. Methods: We retrospectively evaluated 171 patients with NSCLC who received lobectomy at our center between September 2017 and February 2018. The Mandarin Chinese version of the Leicester Cough Questionnaire (LCQ‐MC) was used to evaluate the degree of cough in patients. Postoperative cough was assessed by a visual analog scale (VAS). Results: The total LCQ‐MC score for the whole group was 19.79 ± 0.53 before surgery and 18.40 ± 0.70 after surgery (p < 0.001). Logistic regression analysis showed that right lung cancer, difficult airway, acute cough and history of COPD were independent predictors of chronic cough. Of the 68 patients diagnosed with chronic cough, 41 received acupuncture therapy (acupuncture therapy group), and 27 received no acupuncture therapy (no therapy group). No significant difference was found between the two groups in terms of their LCQ‐MC scores at eight weeks after surgery (p = 0.756). However, the acupuncture therapy group had a significantly higher LCQ‐MC score than the no therapy group at 10 weeks after surgery (p = 0.002). Conclusions: Right lung cancer, difficult airway, acute cough, and history of COPD are independent predictors of chronic cough after surgery. For patients with chronic cough, acupuncture therapy can shorten the recovery time and improve quality of life after surgery. [ABSTRACT FROM AUTHOR]

Chronic cough is common in the population, and among some there is no evident medical explanation for the symptoms. Such a refractory or idiopathic cough is now often regarded as a neuropathic disease due to dysfunctional airway ion channels, though the knowledge in this field is still limited. Persistent coughing and a cough reflex easily triggered by irritating stimuli, often in combination with perceived dyspnea, are characteristics of this disease. The patients have impaired quality of life and often reduced work capacity, followed by social and economic consequences. Despite the large number of individuals suffering from such a persisting cough, there is an unmet clinical need for effective cough medicines. The cough treatment available today often has little or no effect. Adverse effects mostly follow centrally acting cough drugs comprised of morphine and codeine, which demands the physician's awareness. The possibilities of modulating airway transient receptor potential (TRP) ion channels may indicate new ways to treat the persistent cough "without a reason". The TRP ion channel vanilloid 1 (TRPV1) and the TRP melastin 8 (TRPM8) appear as two candidates in the search for cough therapy, both as single targets and in reciprocal interaction. [ABSTRACT FROM AUTHOR]

In non-smokers without intake of an ACE-inhibitor, the three most common causes of chronic cough are eosinophilic airways disease (asthma or eosinophilic bronchitis), Upper-airway-cough-syndrome (UACS) and Gastro-esophageal-reflux desease (GERD). In smokers, chronic bronchitis and COPD are common causes as well. In patients with a normal chest X-ray and lack of information on a less frequent cause in history and physical examination, it is recommended therefore to routinely look for these diseases and/or to treat them empirically [ABSTRACT FROM AUTHOR]

Cough associated with cancer or nonmalignant chronic disease is common and distressing. Levodropropizine, a peripherally acting drug, has been used as an alternative antitussive to opioids. The authors aimed to determine the efficacy and safety of levodropropizine in relieving cough associated with cancer or nonmalignant chronic disease. The authors searched five databases and hand searched relevant journals to identify randomized and nonrandomized controlled trials assessing the antitussive effect of levodropropizine for cough associated with cancer, chronic obstructive pulmonary disease (COPD), interstitial lung disease, or chronic heart failure. Study quality was assessed using a modified version of the Centre for Reviews and Dissemination criteria. The search yielded 58 references. Six were checked in more detail, and four studies were included. Two were randomized controlled trials (RCTs) testing levodropropizine against dihydrocodeine and moguisteine, and two were nonrandomized placebo-controlled studies, all with important limitations and high risk of bias. Levodropropizine was significantly more effective than placebo in reducing cough frequency and severity, and equally effective as dihydrocodeine or moguisteine. It was generally well tolerated. The authors conclude that the evidence for the antitussive efficacy of levodropropizine in these patients is scarce, and is further limited by the methodological weaknesses of the primary studies. Further well-designed research is needed to support its use. [ABSTRACT FROM AUTHOR]

Abstract: Chronic cough remains a challenge to many clinicians because there is often no diagnostic link to causation, and because indirect antitussives are largely ineffective. Chronic cough can also be a predominant symptom associated with many chronic respiratory diseases such as COPD, asthma and pulmonary fibrosis. Chronic cough itself does impair the quality of life and is associated with psychological impairment. The symptoms associated with chronic cough include persistent tickling or irritating sensation in the chest or throat, hoarse voice, dysphonia or vocal cord dysfunction. Currently, the clinical diagnosis of cough is associated with chronic cough caused by airway eosinophilic conditions such as asthma, gastrooesophageal reflux disease or post-nasal drip (or upper airway syndrome), which implies cause and effect, or with chronic cough associated with other diseases such as COPD, cancer or heart failure, that does not necessarily imply cause and effect. A recently-recognised category is idiopathic cough, with no associated or causative diagnosis. We suggest that there is a better label needed for chronic cough, that includes the common association with a hypersensitive cough response to tussive stimuli such as capsaicin or citric acid. This would invoke a hypersensitive syndrome, and there are good reasons to use a new label that would encompass the problem of chronic cough: the chronic ‘cough hypersensitivity syndrome’. This would focus the problem on the cough symptomatology and lead to greater focus on understanding the mechanisms of cough sensitisation, with the ultimate aim of obtaining more effective antitussives. [Copyright &y& Elsevier]

Upper-airway cough syndrome often coexists with other diseases that elicit chronic cough. However, the concomitant conditions are not always relevant to chronic cough, which complicates the cause diagnosis of chronic cough. The objective of this study was to explore the diagnosis and clinical implication of upper-airway cough syndrome with latent eosinophilic bronchitis. Eleven patients with upper-airway cough syndrome and latent eosinophilic bronchitis were retrospectively analyzed for their clinical manifestations, changes of eosinophilia in induced sputum, and cough threshold with capsaicin defined as capsaicin concentration that elicits two or more coughs (C2) and five or more coughs (C5) between pretreatment and post-treatment. All patients reported a history of allergic rhinitis, showed persistent dry cough or small amounts of viscid sputum with a time course of 2–60 months (median = 7 months), and presented with symptoms and signs of rhinitis, normal lung function, and airway responsiveness. Initial eosinophil percentage in induced sputum was 3.5–8.0%. Cough disappeared after 2–5 (3 ± 1) weeks of only oral antihistamine. With successful treatment, cough threshold C2 increased from 1.73 ± 1.45 to 4.43 ± 4.50 μmol/L ( t = 2.64, P = 0.025) and C5 increased from 2.79 ± 2.16 to 10.10 ± 8.22 μmol/L ( t = 3.10, P = 0.011). However, there was no significant change of eosinophil percentage in induced sputum (4.8 ± 1.5% vs. 4.4 ± 1.4%, t = 0.84, P = 0.427). Upper-airway cough syndrome with latent eosinophilic bronchitis is a unique condition. The recognition of the entity may avoid unnecessary use of corticosteroids. [ABSTRACT FROM AUTHOR]

Chronic cough is a common problem in patients visiting physicians and its prevalence in different populations range from 3 to 40%. Postnasal drip, asthma and gastroesophageal reflux are the known cause of chronic cough. Although diagnosis of asthma is usually made by clinical signs and spirometeric results, methacholine challenge test is a good diagnostic test in patients who show normal physical examination and spirometeric results. In this study, the results of methacholine challenge test in chronic cough patients are investigated. This is a cross sectional study performed on patients suffering from chronic cough (over 8 weeks), who went to Pulmonary Disease Clinic of Imam Khomeini Hospital in 2006. Postnasal drip, gastroesophageal reflux was evaluated and ruled out in all patients. Then they were tested by methacholine inhalation using low to high doses of methacholine. The results of test was defined as 20% fall in FEV1 and its relationship with age, sex, history of allergic disease, family history of asthma and smoking status was investigated. 81 patients (36 female and 45 male) entered this study who had mean age of 32.5 ± 13.06 years. 81.5% of patients had never smoked or closed contact with smokers, 6.2% were passive smokers, 8.6% were smokers and 3.7% had quit smoking. 37% had suffered from chronic cough less than 6 months, 11% for 6-11 months and 52% for more than 12 months. In 26% of patients, family history of asthma was present and 34.5% had a history of one type of allergy. In 29.5% the results of methacholine challenge test was positive, among them 45.8% showed an intense response and 54.2% a moderate response. The test results and its intensity had no statistically significant relationship with age, sex, smoking status, the duration of cough and family history of asthma, but the relationship between methacholine challenge test and the history of allergic disease was significant. Methacholine challenge test can be used as a diagnostic test in patients suffering from chronic cough of unknown origin and patients whose clinical and paraclinical finding are normal. A positive test indicates hypersensitivity of airways which can be used for planning their treatment. [ABSTRACT FROM AUTHOR]

The article evaluates the role of exhaled nitric oxide (NO) for the investigation of chronic cough, especially of nonasthmatic eosinophilic bronchitis (NAEB). The results indicate that exhaled NO measurement may be useful as part of the initial evaluation for chronic cough, especially for the exclusion of NAEB. A low level of NO suggested little likelihood of NAEB for the nonasthamtic patients with chronic cough.

Abstract: Eosinophilic airway inflammation may be encountered in asthma and in non asthmatic eosinophilic bronchitis, which is a recently identified and common cause of chronic cough. Non asthmatic eosinophilic bronchitis may be differentiated from asthma by the absence of airflow limitation and of bronchial hyperreactiveness (potentially reflecting the different localization of mast cells within the airway wall). Diagnosis is based on the confirmation of eosinophilic airway inflammation, usually by induced sputum, in the absence of other causes of chronic cough or of radiological and lung function abnormality. The cough is generally improved by inhaled corticosteroids. The long-term outcome is still not known; non asthmatic eosinophilic bronchitis may lead to the onset of fixed airway obstruction or asthma. [Copyright &y& Elsevier]

Chronic cough is a common symptom but only a fraction of patients seek medical attention. Addressing the causes of chronic cough may lead to control of cough; however, this approach is not always successful since there is a certain degree of failure even when the cause(s) of cough are adequately treated; in idiopathic cough, there is no cause to treat. Persistent cough may be associated with deterioration of quality of life, and treatment with cough suppressants is indicated. Currently available cough suppressants include the centrally acting opioids such as morphine, codeine, and dextromethorphan. Peripherally acting antitussives include moguisteine and levodropropizine. Early studies report success in reducing cough in patients with chronic bronchitis or COPD; however, a carefully conducted study showed no effect of codeine on cough of COPD. Success with these cough suppressants can be achieved at high doses that are associated with side effects. Slow-release morphine has been reported to be useful in controlling intractable cough with good tolerance to constipation and drowsiness. There have been case reports of the success of centrally acting drugs such as amitryptiline, paroxetine, gabapentin, and carbamezepine in chronic cough. New opioids such as nociceptin or antagonists of TRPV1 may turn out to be more effective. Efficacy of cough suppressants must be tested in double-blind randomised trials using validated measures of cough in patients with chronic cough not responding to specific treatments. Patients with chronic cough are in desperate need of effective antitussives that can be used either on demand or on a long-term basis. [ABSTRACT FROM AUTHOR]

Abstract: Cough is the most common complaint that leads patients to seek medical attention. Especially chronic persistent cough is annoying, and requires appropriate diagnosis and treatment. Recent cough guidelines and original papers on cough epidemiology from various countries show remarkable differences in the aetiology of chronic cough among countries, especially between US, UK and Japan. Entities associated with rhinosinus disease (post-nasal drip/upper airway cough syndrome reported from the US, rhinitis or rhinosinusitis from the UK, and sinobronchial syndrome from Japan), and eosinophilic lower airway disorders (cough variant asthma, non-asthmatic eosinophilic bronchitis and atopic cough) are most confusing and might involve significant overlap. In this article, issues related to chronic cough aetiology are discussed, including geographic issues, e.g. ‘simple’ geography or difference in race, and difference in patient characteristics possibly arising from difference in the medical system. [Copyright &y& Elsevier]

The reported studies suggest a role for eosinophils in the pathogenesis of cough variant asthma. In the present study, the expired breath condensate level of hydrogen peroxide and pH were determined in patients with cough variant asthma and compared to subjects with classical asthma, with chronic cough nonasthmatic and healthy control. Twenty-seven patients with cough variant asthma, 43 patients with classical asthma, 32 patients with chronic cough and 27 healthy subjects were studied in a cross-sectional study. Hydrogen peroxide concentration was significantly higher in cough variant asthma as compared to chronic cough nonasthmatic patients and healthy control subjects, while pH level was significantly lower in cough variant asthma as compared to chronic cough nonasthmatic patients and healthy control subjects. However, there was no significant difference in expired breath condensate hydrogen peroxide and pH between cough variant asthma and classical asthma. In conclusion, hydrogen peroxide concentration and pH of expired breath condensate may be used as noninvasive markers to differentiate cough variant asthma from chronic cough. [ABSTRACT FROM AUTHOR]

The article presents evidence for the diagnosis and treatment of cough due to chronic bronchitis. Chronic bronchitis is a bronchi disease where there is occurrence of cough and sputum expectoration when other respiratory or cardiac causes for the chronic productive cough are not considered. It is a cough phlegm syndrome and is caused by the interplay of noxious inhaled agents host factors. This interaction results in chronic inflammation in the walls and lumen of the airways. Researchers have found that avoidance is the most effective way to reduce or eliminate cough in patients with chronic bronchitis.

This article focuses on a study related to the assessment of citric acid cough threshold (CACT) in patients with chronic cough due to gastroesophageal reflux disease (GERD) before and 3 months after laparoscopic Toupet fundoplication. GERD is among the most common causes of chronic cough in all age groups, exceeded in frequency only by postnasal drip syndrome and asthma. Moreover, chronic cough can be the sole presenting manifestation of GERD. However, up to 75% patients with GERD-induced cough may have no GI symptoms. In this preliminary study in a group of GERD patients with chronic cough before antireflux surgery, the researchers observed the relationship between subjective and objective evaluations of cough and means of CACT values.

Prevalence and clinical features of cough variant asthma in a general internal medicine outpatient clinic in JapanSHIRAHATA K, FUJIMOTO K, ARIOKA H, SHOUDA R, KUDO K, IKEDA S.Respirology2005;10: 354–358The aims of the present study were to examine the prevalence and clinical features of cough variant asthma (CVA) among patients with chronic and persistent cough at an outpatient clinic in Japan, and the efficacy of treatment with an inhaled corticosteroid.This prospective study was conducted at a general internal medicine outpatient clinic in Japan over a 12-month period. CVA was diagnosed as chronic cough without wheezing or any apparent cause, that had persisted for more than 8 weeks, with a normal CXR and spirometry but with bronchial hyperresponsiveness to methacholine, and relief of cough after bronchodilator treatment. We also examined the effects of inhaled beclomethasone propionate on symptoms and differences in PEF between early morning and evening.Of 55 patients suffering from chronic cough, 23 satisfied the criteria for CVA. Their cough occurred more frequently at night and early in the morning. Early morning PEF was significantly lower than evening PEF with a mean variability of 11.5 ± 4.1%. Treatment with beclomethasone propionate improved coughing and significantly increased early morning PEF, reducing variability to less than 10%.These findings suggest that CVA is most common among patients with chronic cough not due to any apparent cause. The efficacy of inhaled corticosteroid suggests that early intervention is effective in the treatment of CVA. [ABSTRACT FROM AUTHOR]

TRPV1 is a modulator of noxious stimuli known to be important in the cough reflex. We have compared the expression of TRPV1 in normal human airways and those from patients with chronic cough and found that there is up regulation in airways smooth muscle in disease. This increased expression appears to be intracellular and we have therefore examined the role of intracellular rat and human TRPV1 activity was found using intracellular calcium signalling with human intracellular TRPV1 being located in a thapsigargin insensitive compartment. Increase in TRPV1 activity may have a role in the airway hypersensitivity seen in chronic cough. [ABSTRACT FROM AUTHOR]

Importance of atopic cough, cough variant asthma and sinobronchial syndrome as causes of chronic cough in Hokuriku area of JapanFUJIMURA M, ABO M, OGAWA H, NISHI K, KIBE Y, HIROSE T, NAKATSUMI Y, IWASA K.Respirology2005;10: 201–207A prospective multicentre study was conducted to elucidate the causes of chronic cough in Japan.All consecutive and unselected patients complaining of cough lasting 8 weeks or more, who visited our clinics from 1 June to 31 December 2001, were registered. The causes of chronic cough were diagnosed based on the criteria for definite and probable causes of cough as recommended by the Japanese Cough Research Society.Of the 248 patients enrolled, 72 patients (29.0%) were unavailable for follow up before their diagnostic assessment had been finalized. Among the 176 patients who were adequately assessed, a diagnosis was made in 165 patients (93.7%) either as single cause or as one of two casuses: atopic cough in 48 (29.1%) and 11 patients (6.7%); cough variant asthma in 46 (27.9%) and nine patients (5.5%); cough predominant asthma in 14 (8.5%) and three patients (1.8%); and sinobronchial syndrome (SBS) in 28 (17.7%) and 14 patients (8.5%), respectively. A diagnosis of gastro-oesophageal reflux-associated cough was made in a total of four patients (2.4%).Atopic cough, asthmatic cough consisting of cough variant asthma and cough predominant asthma, and SBS are major causes of chronic cough in Japan. [ABSTRACT FROM AUTHOR]

Abstract: Airway mucosal changes have been reported in chronic cough. In cough variant asthma and in eosinophilic bronchitis, there is evidence of eosinophil infiltration and sub-basement membrane thickening. In non-asthmatic cough, an increase of bronchoalveolar mast cells, mucosal mononuclear cells, and epithelial shedding have been reported. In a more recent study, evidence of airway wall remodelling has been observed in both asthmatic and non-asthmatic cough, such as an increase in sub-basement membrane thickness, goblet cell area, vascularity and vessel size. Smooth muscle area was increased in non-asthmatic coughers. Heightened cough sensitivity in non-asthmatic coughers was related to the degree of goblet cell hyperplasia and epithelial shedding. Cough reflex may be heightened by increased production of growth factors that might be further enhanced by the physical effects of cough on the airways. Mast cells may participate in the cough pathophysiology through release of growth factors as well as tussive mediators. Changes in the airway wall mucosa and epithelium may be important in the pathogenesis of cough receptor sensitization. [Copyright &y& Elsevier]

It is important to make a differential diagnosis of cough variant asthma in patients with chronic cough. To examine whether or not peak expiratory How rate (PEFR) is useful for the differential diagnosis of cough variant asthma in such patients, diurnal variation rates of PEFR were calculated in 23 patients who presented with dry cough lasting four or more weeks and who showed no abnormalities on chest radiographs. None of the patients had wheezes, and pulmonary function testing at the time of visit to the hospital revealed no abnormalities. During the control period, the mean diurnal variation rate of PEFR in 23 patients was 16.3 ± 7.9%. Six, nine and eight patients had PEFR diurnal variations rates of <10% (Group 1). 10-19% (Group 2), and ≥ 20% (Group 3). respeetively. At week 3 of treatment with bronchodilators, only Group 3 showed a significant decrease in PHFR diurnal variation rate from 25.7% to 10.1%. The cough score decreased significantly in Group 3 only. These patients had enhanced bronchial hyperresponsiveness and showed eosinophils in induced sputum, leading to the diagnosis of cough variant asthma (CVA). After making the diagnosis of CVA, an inhaled corticosteroid or a Th2 cytokine production inhibitor suplatast tosilate was administered to patients; consequently, they showed no recurrence of cough. PEFR monitoring allowed the detection of morning dip and was suggested to be potentially useful for the differential diagnosis of cough variant asthma in patients with chronic cough. [ABSTRACT FROM AUTHOR]

Chronic cough is defined as persistent cough for more than eight weeks without a defined diagnosis. Irwin and other authors have identified sinusitis, asthma and gastroesophageal reflux as the most common causes of chronic cough. Objectives: To know the clinical spectrum and the most common causes of chronic cough, as well as lo perform a comparative analysis with the literature. Material and methods: A retrospective and transversal study was performed analyzing the clinical records of patients attending consultation because of chronic cough at Dr. Jose E. Gonzalez University Hospital at the Autonomous University of Nuevo Leon, and the Clínica Cuauhtemoc y Famosa, in Monterrey, Nuevo Leon, Mexico, from January, 1998, to December, 2000. The main symptoms and signs of each patient were analyzed, as well as the final diagnosis of the cough's cause and the response to treatment. In addition, a comparative analysis of the data found. In this population and those reported by Irwin et al on the main cause of this symptom. For the statistical analysis, multivarianza analysis, x2 test and Mantel Haenszel with 2x2 table were used considering a p < 0 05 as significant. Results: One hundred eight records were reviewed, but only 91 were included. The most common final diagnoses were gastroesophageal reflux in 75 patients (82%), followed by sinusitis in 34 cases (37%) and mixed causes (more than two) in 25 subjects (27%) (p = 0 016). All patients responded properly to specific treatment directed to the identified base-disease, with which symptoms were solved. Conclusions: In our population, unlike described by Irwin, the most frequent cause of chronic cough is gastroesophageal reflux, followed by sinusitis and mixed causes. [ABSTRACT FROM AUTHOR]

Cough is the common symptom of patients who seek medical attention; chronic cough being defined as persistent cough longer than three weeks without a definite diagnosis. Cough is a vagal phenomenon which can be initiated in structures with afferences of the vagus or its branches; besides, cough receptors have been described in different parts of the body, mainly tracheobronchial and digestive tract structures, which send afferents to the central nervous system to form the cough reflex. Main causes of chronic cough are retronasal discharge syndrome, gastroesophagic reflux and asthma. The diagnosis of chronic cough requires a careful history and physical examination and paraclinic tests focused on the most frequent causes. Treatment is oriented to identify and correct the disease; anticough medication should be used carefully since cough is a defense mechanism and an alarm sign. [ABSTRACT FROM AUTHOR]

The article provides information on a study regarding the chronic and persistent cough related to vulnerability to psychological stress. Various cases of children with chronic barking cough related to vulnerability to psychological stress are also presented. Major causes of chronic cough in adulthood are asthma, post-nasal drip syndrome, and gastroesophageal reflux disease.