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Cough and asthma diagnosis: physicians’ diagnosis and treatment of patients complaining of acute, subacute and chronic cough in rural areas of Japan

Akira Yamasaki1, Keichi Hanaki2, Katsuyuki Tomita3, Masanari Watanabe1, Yasuyuki Hasagawa1, Ryota Okazaki1, Miki Yamamura1, Kouji Fukutani4, Yuji Sugimoto5, Kazuhiro Kato4, Masahiro Kodani6, Toshikazu Ikeda7, Tatsuya Konishi8, Yuji Kawasaki9, Hirokazu Tokuyasu9, Hiroki Yajima3, Hitoshi Sejima10, Takeshi Isobe11, Eiji Shimizu1, SAN-IN Asthma Research Group

1Third Department of Internal Medicine, 2Department of Pediatrics, Tottori University, Japan; 3Department of Respiratory Medicine, Hakuai Hospital, Japan; 4Department of Respiratory Medicine, San-in Rosai Hospital,  Japan; 5Department of Respiratory Medicine, Tottori Prefectural Central Hospital, Japan; 6Department of Respiratory Medicine, Tottori Red Cross Hospital, Japan; 7Department of Respiratory Medicine, National Organization, Matsue Hospital, Japan; 8Department of Respiratory Medicine, Matsue City Hospital, Japan; 9Department of Respiratory Medicine, Matsue Red Cross Hospital, Japan; 10Department of Pediatrics,  11Department of Internal Medicine, Shimane University, Shimane, Japan

Background: Cough is one of the most common reasons for visiting a clinic. The causes of cough differ according to the duration of cough. Infectious disease is commonly observed in acute cough while noninfectious disease is commonly observed in chronic cough. On the other hand, cough is frequently observed in patients with asthma/cough variant asthma (CVA).

Objective: In this study, we investigated the causes of cough in a rural region in Japan and the clinical examination and treatment for the patients diagnosed as asthma/CVA.

Methods: We analyzed 124 patients who complained of cough.

Results: The most common reason for acute cough was respiratory tract infection while asthma/CVA is the most common reason for subacute and chronic cough. The diagnostic procedure for asthma/CVA depends on clinical symptoms in asthmatic patients with acute cough. While in asthmatic patients with subacute and chronic cough, diagnosis of asthma depends on clinical examinations including chest radiogram, immunoglobulin E, white blood cells counts, sputum examination or spirometry as well as symptoms. For the treatment of asthma, the use of long-acting β2-stimulant was dominant in asthmatic patients with acute cough while the use of leukotriene receptor and inhaled corticosteroid were dominant in asthmatic patients with subacute or chronic cough.

Conclusions: Diagnosis and treatment for asthma differs according to the duration of cough. Simple guidelines for asthma/CVA according to the duration of cough might be necessary for diagnosis and treatment of asthma/CVA for general physicians especially in rural areas.

Keywords: cough, diagnostic procedures, cough variant asthma, asthma

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