xRead - Globus and Chronic Cough (April 2024)

Commentary

Otolaryngology– Head and Neck Surgery 144(3) 348–352 © American Academy of Otolaryngology—Head and Neck

Cough: A New Frontier in Otolaryngology

Surgery Foundation 2011 Reprints and permission:

sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599810396136 http://otojournal.org

Kenneth W.Altman, MD, PhD 1 and Richard S. Irwin, MD 2

No sponsorships or competing interests have been disclosed for this article.

into perspective for our readers, otolaryngologists saw a total of only 17 million visits for all diagnoses in that same year. Acute cough (<3 weeks), subacute cough (lasting 3-8 weeks), and chronic cough (>8 weeks) have well-defined and often different common causes, and the treating physician should be well versed in this duration-based classification. 1 Although the most common cause of acute cough is the self-limited common cold, it is expected that most ambulatory medical practice visits are related to conditions causing a chronic cough. In the latter situation, multiple simultaneous causes contributing to the cough are commonly present. The otolaryngologist is in a unique position to champion and coordinate care for these complex patients. In addition to the large unserved need for otolaryngologists to help in caring for cough patients, there are other challenges. The high cost of health care is creating a movement toward lowering costs, improving outcome, and increasing value in health care. 3,4 For many conditions, this is best performed through a coordinated team approach to disease management called integrated practice units . Examples include head and neck cancer and pediatric cleft-palate clinics. Cough is also an ideal problem to pursue this concept because it involves a broad array of medical and surgical specialties. In addition, there is similarly a broad array of diagnostic and therapeutic procedures involved in managing chronic cough patients. The concept of partnerships between medical professionals in the management of chronic cough has been emphasized in a recent publication. 5 In this series of papers, the use of evidence based clinical practice guidelines was promoted to establish agreement among different specialists in the evaluation and man agement of cough patients. Those involved in the care of cough patients include specialists in otolaryngology, pulmonology and chest, allergy and immunology, gastroenterology, neurology, car diology, infectious disease, speech and swallowing, and psychia try. Therefore, the interdisciplinary nature of cough being a 1 Department of Otolaryngology–Head & Neck Surgery, Mount Sinai School of Medicine, New York, NY, USA 2 Division of Pulmonary,Allergy, and Critical Care Medicine, University of Massachusetts,Worcester, MA, USA Corresponding Author: Kenneth W.Altman, MD, PhD, Department of Otolaryngology–Head & Neck Surgery, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1189, New York, NY 10029, USA Email: kenneth.altman@mountsinai.org

Abstract Both acute and chronic cough are responsible for a significant portion of all ambulatory medical visits annually, over-the counter self-medication expenses in excess of $3.6 billion in the United States, and impaired quality of life.Yet otolaryngol ogists only see a small portion of these patients.The diagnosis of cough can be simple or profoundly challenging, and it may be a sentinel indicator of severe underlying disease. The list of diseases that may induce cough is growing, along with an appreciation of their interrelations. These include upper and lower airway diseases, related through the unified airway con cept. Gastroesophageal reflux, aspiration, neurologic reflexes, tumor, and systemic diseases are also important. Otolaryn gologists are playing an increasingly valuable role in the multi disciplinary approach to these challenging cough patients and master many procedures associated with their evaluation and treatment.There are also leadership opportunities in building coordinated teams to further patient care. Keywords cough, interdisciplinary, integrated process unit, aerodigestive tract, outcomes, value in health care C ough is truly a global problem with significant rele vance to public health. For the patient, it can be an incapacitating nuisance or a sentinel for life-threatening disease. For civilization, it can be the conduit to an epidemic; for the physician, it can be a confluence of interrelated dis eases, presenting a diagnostic and management dilemma. The cost associated with delay in diagnoses and the many manage ment options is consequently very high. The prevalence of chronic cough is 9% to 33% worldwide, 1 and in the United States, over-the-counter cough medication sales are approaching $3.6 billion annually. According to the 2007 National Ambulatory Medical Care Survey, cough is the leading diagnosis for outpatient visits to physicians (behind general medical exam and nonspecific progress visit) and is responsible for 27 million (about 3.1%) of ambulatory medi cal practice visits in the United States. 2 To put these numbers Received November 29, 2010; accepted December 9, 2010.