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Strategies for Managing Chronic Cough

Strategies for Managing Chronic Cough

Chronic cough, or cough that persists beyond 8 weeks, has a prevalence of 9% to 33% in all age groups. Chronic cough can cause rib fractures, syncope, anxiety, physical discomfort, and embarrassment. Treating the underlying causes of chronic cough is key to  management. In some cases, it can be complicated for clinicians. Determining Causes “When trying to determine the cause of chronic cough, memorizing a list of top causes can be counter-productive,” says Kaiser G. Lim, MD, author of a recent update on chronic cough that was published in Mayo Clinic Proceedings. “Instead, it’s more effective to approach chronic cough algorithmically. Physicians should consider various factors that can irritate the laryngopharyngeal area, such as polyps, granulomas, post-nasal drip, and cigarette smoking. The laryngopharyngeal area is where there is the highest concentration of cough receptors.” Dr. Lim recommends exploring the respiratory tract below the vocal cords after the laryngopharyngeal area, considering other potential causes like bronchitis, sarcoidosis, bronchiectasis, and endobronchial tumors. “If providers consider and explore these two areas, there’s no need to memorize a list of top causes of chronic cough,” he says. He cautions clinicians to not provide purely symptom-directed treatment. Laboratory and radiographic testing should be guided by the patient history. Many intrathoracic abnormalities can be excluded with a chest x-ray, but without it, physicians can miss some types of cancer, sarcoidosis, lung collapse, and other health problems. “If a physician thinks that cough is due to airway disease,” Dr. Lim says, “then patients may mistakenly be treated for that problem without performing the necessary relevant studies.” An Algorithmic Approach When taking an algorithmic approach to chronic...
Flu Vaccination & Cardiovascular Outcomes

Flu Vaccination & Cardiovascular Outcomes

Studies have shown that recent influenza-like infection is a non-traditional cardiovascular disease (CVD) risk factor that has been linked to fatal and non-fatal atherothrombotic events. “There is interest in learning more about the potential association between influenza and subsequent CVD events,” says Jacob A. Udell, MD, MPH, FRCPC. A Systematic Review & Meta-Analysis Small, observational randomized clinical trials (RCTs) have suggested that influenza vaccination helps reduce the risk of cardiovascular events, leading several medical associations to recommend universal vaccination in patients with or at risk of CVD. In an issue of JAMA, Dr. Udell and colleagues had a study published that more closely examined the link between flu vaccinations and prevention of cardiovascular events. The systematic review and meta-analysis consisted of RCTs of influenza vaccine that studied cardiovascular events as efficacy or safety outcomes. For the study, five published RCTs and another unpublished RCT involving more than 6,700 patients in total met inclusion criteria. Analyses were stratified by subgroups of patients with and without a history of acute coronary syndrome (ACS) within 1 year of randomization. Fewer patients treated with the flu vaccine developed a major adverse cardiovascular event when compared with placebo or control groups (2.9% vs 4.7%, respectively). The addition of the unpublished data did not materially change the results. “The potential impact that this preventive strategy may have on high-risk CVD patients is significant.” “The greatest treatment effect was seen among patients with recent ACS,” adds Dr. Udell. In a subgroup analysis of three RCTs of patients with pre-existing coronary artery disease (CAD), the risk of major adverse cardiovascular events among patients with a history of...
Reality Check: Hospital Patient Safety Scores

Reality Check: Hospital Patient Safety Scores

Imagine you are sick and live in the upper Manhattan section of New York City. Your doctor tells you that you need major surgery. Luckily, you have excellent insurance and can go anywhere in the city for that operation. Being an intelligent consumer, you decide to check HospitalSafetyScore.org, which is sponsored by the Leapfrog Group, a nationally known patient safety organization. You pull up a handy map of upper Manhattan and the lower Bronx to check the safety scores of hospitals in the area near your neighborhood. A hospital on the Manhattan side (orange arrow) has a safety score of only “C,” whereas another upper Manhattan hospital (green arrow) has a “B” rating, and over in the Bronx, there is an “A”-rated hospital (blue arrow). It’s a no-brainer, right? Clearly, the least safe of the three is the one with the “C” rating. But consider this. The “A”-rated hospital is Lincoln Medical and Mental Health Center, and the “B”-rated Hospital is Harlem Hospital Center. Both are teaching hospitals owned and run by the city of New York. But there is little research going on in either, and there are no regionally or nationally recognized experts in just about any specialty of medicine or surgery practicing there. The “C”-rated hospital is New York Presbyterian, the main teaching hospital of Columbia University’s medical school. A 2012 patient safety study by Consumer Reports listed the 30 worst hospitals for patient safety in the New York metropolitan area. Lincoln was the 16th worst, and Harlem was 23rd. Presbyterian did not make that list. Healthgrades rated New York Presbyterian as #5 of 203 hospitals in...
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