Lung India (Jan 2007)
Investigation of chronic cough in tropics:A cost effective analysis
Abstract
Objectives: To ascertain the validity of anatomic diagnostic protocol in determin-ing the etiology of chronic cough in tropics and a cost analysis of the protocol to ascertain effective ways of managing patients with chronic cough. Methods: A prospective, descriptive, study of non-smoking patients with chronic cough. All patients were evaluated by a validated anatomic diagnostic protocol. The diagnostic protocol was modified to include sputum examination for acid-fast bacilli, absolute eosinophil count and stool examination. The final diagnosis was based on radiological, laboratory findings and a successful response to therapy. Results: Eighty-seven consecutive patients with chronic cough were evaluated from February 2000 to February 2002 using the modified diagnostic protocol. The mean age ±S.D. was 35.00±11.85 years. Forty-nine patients were males. Etiology of chronic cough was established in 86 (99%) patients. Cough resolved in 99% of patients after successful diagnosis and treatment. The three most common causes were Postnasal drip syndrome (PNDS), 52%, Asthma, 41%, and Loeffler′s syn-drome, 8%. Pulmonary tuberculosis was confirmed in 5% of patients. Hence, 13% of patients had conditions more prevalent in the tropics. Gastroesophageal reflux disease (GERD) was seen in 6%. Rare causes of chronic cough included congestive cardiac failure (CCF) 2%. Cough was due to multiple causes in 15%. The average cost per patient was Rupees (RS) 878.55 (1US$=RS 45). However if we use the pro-tocol proposed at the end of study the average cost per patient will be RS 743.55. Using the modified diagnostic protocol 90% of patients were diagnosed with mini-mal investigations making it cost effective. Conclusion: The three most common causes of chronic cough in the tropics are different from the west. Pulmonary tuberculosis and Loeffler′s syndrome are more prevalent and need to be considered. Using a modified diagnostic protocol etiology of chronic cough can be determined successfully in tropical countries in most patients. A cost effective way of evaluating cough has been proposed.
