Structured Approach to Acute and Subacute Cough: Identifying Causes and Ensuring Timely Care

Indian Medical Association provides a structured approach to an efficient path for diagnosis and intervention, enabling healthcare providers to address acute and subacute coughs according to urgency and root causes
1. Initial Assessment: Gathering Key Information  
The first step involves a detailed patient history and physical examination, which helps in understanding potential causes and identifying any concerning symptoms.
2. Non-Life-Threatening Causes  
  a. Infectious Factors  
      - Lower Respiratory Tract Infections: Acute bronchitis, tuberculosis, and pertussis are common culprits affecting the lower respiratory system.
      - Upper Respiratory Tract Infections: Conditions like rhinitis, pharyngitis, and sinusitis often contribute to upper respiratory coughs.
   b. Non-Infectious Factors  
      - Chronic conditions such as asthma, bronchiectasis, and chronic obstructive pulmonary disease (COPD) are common non-infectious sources of cough, requiring ongoing management.
3. Red Flags: Recognizing Serious Conditions  
Coughs accompanied by symptoms of pneumonia, pulmonary embolism, heart failure, pleurisy, or pneumothorax signal urgent issues that need immediate attention to prevent severe outcomes.
4. Urgent Response and Referral  
For cases with red-flag symptoms, a rapid severity assessment and immediate action are crucial. Referral to a specialist may be necessary for advanced care, ensuring the patient receives comprehensive treatment.
This structured approach ensures an efficient pathway to diagnosis and intervention, helping healthcare providers manage acute and subacute coughs based on urgency and underlying causes.
 

Montelukast Sodium Combination Therapy Significantly Improves Outcomes in Pediatric Cough Variant Asthma

A recent meta-analysis has demonstrated the clinical efficacy of montelukast sodium combination therapy for children with cough variant asthma (CVA). This study reviewed 18 clinical trials from Chinese populations, comparing combination therapy (montelukast sodium plus standard treatments) to control treatments, which included budesonide, fluticasone propionate, salmeterol-fluticasone, or ketotifen alone.
The analysis revealed that the combination therapy group had a significantly higher effective treatment rate (relative ratio [RR]: 1.23, 95% confidence interval [CI]: 1.18-1.29, p < 0.001) than the control group, with no significant difference in adverse reactions between groups (RR: 0.65, 95% CI: 0.42-1.02, p = 0.060). 
Pulmonary function parameters, including peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC ratios, were significantly improved in the combination therapy group compared to controls (p < 0.001).
Moreover, the combined therapy resulted in significantly lower levels of inflammatory markers, including tumor necrosis factor-α (TNF-α), interleukin-4 (IL-4), and IgE, indicating better control of airway inflammation (p < 0.001).
This meta-analysis highlights that montelukast sodium, when used alongside standard asthma treatments, provides superior clinical outcomes in managing pediatric CVA. These findings support the use of combination therapy as a practical approach to improving both respiratory function and inflammation control in children with CVA.
 

Fruit-Flavored E-Cigarettes Linked to Increased Risk of Nocturnal Dry Cough

Although in vitro and animal studies have identified the pulmonary toxicity of electronic cigarette (ECIG) flavors, epidemiological evidence on their respiratory effects remains limited. This study explored the longitudinal association between exposure to flavored ECIGs and the occurrence of nocturnal dry cough among users using data from the Population Assessment of Tobacco and Health Study (2014-2019).
 A secondary analysis was conducted on 18,925 adults, totaling 38,638 observations, employing weighted-incidence estimates and generalized estimating equation models to assess both unadjusted and adjusted associations.
Findings revealed that the weighted incidence proportion (WIP) of nocturnal dry cough was significantly higher among current (WIP: 16.6%) and former fruit-flavored ECIG users (WIP: 16.6%) compared to non-ECIG users (WIP: 11.1%). Current users of fruit-flavored ECIGs had a 40% higher risk of reporting nocturnal dry cough compared to non-users (aRR: 1.40). Former ECIG users of multiple flavors and other flavors had a markedly increased risk of cough, with 300% and 66% higher risks, respectively (aRR: 3.33 and aRR: 1.66).
The significant association between fruit-flavored ECIG use and increased risk of nocturnal dry cough highlights a potential early indicator of respiratory inflammation and disease risk, raising concerns about the respiratory health impact of flavored ECIGs. Further studies are needed to assess the long-term implications of these findings on respiratory health.
 

Sediflù may be Effective for Pediatric Cough, suggests SEPEDIA Clinical Trial

This pilot randomized, double-blind, placebo-controlled, multicenter clinical trial evaluated the efficacy and tolerability of Sediflù, a herbal-based medical device, in treating persistent nocturnal and diurnal cough in children aged 3 to 7 days with either dry or productive cough. The study enrolled pediatric patients experiencing upper respiratory tract infections, assigning them to receive either Sediflù or a placebo.

The primary outcomes included the assessment of Sediflù’s soothing effects on dry and productive coughs both during the day and at night, alongside evaluating cough-related impacts on sleep quality for both the child and their parents, as well as cough frequency and severity.

Results demonstrated significant improvements in both nocturnal and diurnal cough scores in the Sediflù group starting from day 2, with marked reductions in daytime cough severity observed at days 3 and 7. Sediflù was well-tolerated, and its use was associated with notable enhancements in the quality of sleep for both children and their parents.

These findings suggest that Sediflù syrup may serve as an effective and well-tolerated treatment option for managing persistent coughs in young children with upper respiratory infections, potentially reducing cough duration and improving overall quality of life for affected families.