Tuberc Respir Dis.  2004 Dec;57(6):535-542. 10.4046/trd.2004.57.6.535.

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

• Jeon G
• Jang SH
• Song HG
• Ha JW
• Eom KS
• Bahn JW
• Kim DG
• Shin TR
• Park SM
• Park YB
• Kim CH
• Hyun IG
• Jung KS

• KMID: 2133001
• DOI: http://doi.org/10.4046/trd.2004.57.6.535

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.

Keyword

Chronic cough; Diagnostic performance; Cost-effective approach

MeSH Terms

Asthma
Bronchial Provocation Tests
Bronchitis
Cough*
Diagnosis
Eosinophils
Humans
Hypersensitivity
Immunoglobulin E
Methacholine Chloride
Prednisolone
Radiography, Thoracic
Sinusitis
Spirometry
Sputum
Immunoglobulin E
Methacholine Chloride
Prednisolone