Volume 192 - Issue 11
CICADA: Cough in Children and Adults: Diagnosis and Assessment. Australian Cough Guidelines summary statement
Authors: Nicholas J Potter and Eduard I Pudel
Med J Aust 2010; 192 (11): 671-672. || doi: 10.5694/j.1326-5377.2010.tb03682.x
Published online: 7 June 2010
Published online: 7 June 2010
To the Editor: We read with interest the Australian Cough Guidelines summary statement by the CICADA multidisciplinary group.1 However, we feel that the role of direct examination of the upper aerodigestive tract in assessing cough was underemphasised.
Flexible nasal endoscopy (FNE) is a quick, relatively straightforward examination performed under topical anaesthesia as part of an ear, nose and throat (ENT) consultation.
It allows direct visualisation of the nasal cavities, postnasal space, oropharynx and larynx, and can be performed on adults and older children and also some younger children.2
Nasal causes of cough, and hence the potential role of FNE, appear to have received more emphasis in previous chronic cough management strategies, including those proposed by the American College of Chest Physicians in 20063 and the European Respiratory Society task force in 2004.4
The diagnosis of chronic rhinosinusitis or upper airway cough syndrome (postnasal drip syndrome) is enhanced by direct examination.
The presence of mucopus in the middle meatus of the nasal cavity is associated with a positive diagnosis of chronic rhinosinusitis.1
FNE can also provide direct evidence of the presence of gastro-oesophageal reflux affecting the larynx (laryngopharyngeal reflux), and plays a significant role in the clinical diagnosis of laryngopharyngeal reflux.5
FNE should be used in patients with alarm symptoms for serious underlying disease (as suggested by the CICADA group1), particularly those potentially related to laryngeal causes (hoarseness, haemoptysis, feeding difficulties, stridor or smoking).
As part of a complete examination, FNE can help in targeting therapy for two of the three most common causes of cough in adults (gastro-oesophageal reflux and rhinosinusitis), and in excluding some of the significant causes of cough in both adults and children.
It is particularly recommended in patients with a suspected nasal or laryngeal cause, in those with alarm symptoms, and in those for whom initial therapy fails.
References
- Gibson PG, Chang AB, Glasgow NJ, et al. CICADA: Cough in Children and Adults: Diagnosis and Assessment. Australian Cough Guidelines summary statement. Med J Aust 2010; 192: 265-271. 0_BABCCHCE
- Wang D, Clement P, Kaufman L, Derde MP. Fibreoptic examination of the nasal cavity and nasopharynx in children. Int J Pediatr Otorhinolaryngol 1992; 24: 35-44. 0_pgfId-2021956
- Irwin RS, Baumann MH, Bolser DC, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest 2006; 129 (1 Suppl): 1S-23S. 0_BABCBIHF
- Morice AH, Fontana GA, Sovijarvi AR, et al. The diagnosis and management of chronic cough. Eur Respir J 2004; 24: 481-492. 0_i1091875
- Koufman JA, Aviv JE, Casiano RR, et al. Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology — Head and Neck Surgery. Otolaryngol Head Neck Surg 2002; 127: 32-35. 0_i1091879