Prevalence and Main Features of Chronic Refractory Cough.
Prevalence and Main Features of Chronic Refractory Cough.
Cough is among the most common causes of medical consultation in primary care.[1] Chronic
 cough, arbitrarily defined as symptom persisting more than 8 weeks, has been variably
 reported in different settings and geographical area, with an overall prevalence of 10-20% in
 the general population, that increases up to 40-50% in pneumology specialist clinics.[2,3]
 While acute cough is generally caused by the common cold and typically lasts one to three
 weeks, chronic persisting cough can underlie more serious disease processes. Moreover, it can
 impair quality of life,[4] possibly leading to tiredness, urinary incontinence, and
 eventually syncope. It also has psychosocial effects such as embarrassment and negative
 impact on social interactions.

 A careful clinical history may provide important diagnostic clues that allow therapeutic
 trials without the need of further investigations.[5] Smoking history, medication list and
 presence and character of sputum should be carefully detailed. Identification of the causes
 of productive cough is generally straightforward and strategies for intervention and
 treatment are well defined.[5] Conversely, chronic dry or poorly productive cough represents
 a greater diagnostic challenge. Several studies have shown that in nonsmokers with normal
 chest radiography who are not taking ACE-inhibitor, chronic cough is usually due to asthma,
 rhinosinusitis or gastro-esophageal reflux (GER).[6] Many dedicated algorithms have been
 identified to guide the diagnostic phase and to sequentially coordinate the execution of
 further diagnostic deepening and/or empirical treatments, based on cost-effectiveness
 principles.[5,7-9] Among these, the European Respiratory Society (ERS) recommendations[5] are
 widely applied in clinical practice and broadly parallel those released by the American
 College of Chest Physicians[7]. This notwithstanding, a proportion of cases do not reach a
 definite diagnosis and resolutive treatment[7]. This condition is termed chronic refractory
 cough (CRC), chronic idiopathic cough, or unexplained chronic cough.[7,10] It can be
 diagnosed when patients have no identified causes of chronic cough (unexplained or idiopathic
 chronic cough) or when the cough persists after investigation and treatment of cough-related
 conditions. Because patients with unexplained chronic cough often receive specific therapies,
 such as inhaled corticosteroids or proton pump inhibitors, they can also be classified as
 having CRC.

 The real prevalence of CRC is not well-know and many cases of CRC may be actually
 misdiagnoses due an incomplete application of recommended work-up. In the present study we
 aim to estimate the prevalence of chronic cough in different care settings, together with the
 prevalence of CRC according to a systematic and integrated approach. The careful application
 of the recommendation defined by ERS guidelines will allow to detect truly refractory cases
 of chronic cough.
Inclusion Criteria:

 -  complaining chronic cough (lasting more than 8 weeks)

 Exclusion Criteria:

 -  Unwilling to participate