Management techniques in primary and special care

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A clearly integrated care pathway approach was needed for the management of chronic cough. Most patients with chronic cough first see a primary care physician, but due to limited access to advanced diagnostic tests, involving them in optimal management might be difficult. The best way to identify and treat the illnesses that caused or worsened the cough was through a multidisciplinary approach including, among others, gastroenterologists, allergists, otolaryngologists and pulmonologists. These can include upper and lower respiratory tract diseases, viral and inflammatory conditions, or gastroesophageal reflux disease. Despite the vast arsenal of ancillary tests used in the multidisciplinary treatment of cough, such management only occasionally eliminates the cough. This could be partially attributed to the limited information available regarding the effectiveness of tests (such as spirometry and exhaled nitric oxide) and conventional medications used in interdisciplinary specialties for chronic cough. Multiple simultaneous cough trigger mechanisms and central neural entanglement of chronic cough were 2 other significant variables. Cough-specific behavioral counseling and medication using neuromodulators were just a few examples of later management practices used by cough specialists to control coughs that had not responded to earlier interventions. Although preliminary results on the use of neuromodulators as proof of concept were promising, there was not much evidence of their efficacy and safety. The most recent research on the treatment of chronic cough in primary, multidisciplinary and specialist cough care has been reviewed by the World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough. Researchers also analyzed knowledge gaps in behavioral therapy for chronic cough, conventional and neuromodulatory medications, and diagnostic tests. The third part of the WAO/ARIA consensus on chronic cough proposed an algorithm for managing chronic cough as part of an integrated care pathway strategy. Understanding the inherent limitations of multidisciplinary cough diagnostic tests, the efficacy and safety of currently available antitussive medications, or recently recognized behavioral therapy could greatly improve standards of care for patients with chronic cough.

Source:www.sciencedirect.com/science/article/pii/S1939455122000254

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