How does it work?
Chronic cough is defined as a cough lasting for greater than eight weeks and is a disabling symptom with a significant impact on a patient’s quality of life. Cough is the commonest symptom for which medical care is sought and in the absence of any obvious respiratory disease, three common causes have been proposed for chronic cough; reflux disease, an asthma syndrome, and rhinitis. The European Respiratory Society (ERS) guidelines illustrate the development of the approaches to cough.
Weighting system & diagnosis
The diagnosis of the aetiology of cough in a patient requires relevant information from the patient’s medical history followed by the assigning of weighting factors to the information to predict the most likely diagnosis. Correct diagnosis is crucial for an effective therapy. An algorithm is applied to the questionnaire responses, using the weighting factors, to calculate the probability of the three main causes of chronic cough. The condition with the highest percentage is chosen as the most probable diagnosis (reflux, asthma or rhinitis) causing the chronic cough.
When the diagnosis is made the ERS guidelines recommend a therapeutic trial of the most appropriate treatment. The Cough Clinic generates detailed information for the patient along with a letter for the patient to take to their Primary Care Physician. This letter refers to the completed questionnaire, the ERS guidelines and the suggested diagnosis of the cause of the patient’s chronic cough, it also suggests the most suitable treatment trial for the patient.
A clinical evaluation of the online cough clinic was carried on over 2,000 entrants. Of the patients completing a follow-up questionnaire two months after the initial diagnosis 94% said they found the site easy to use, 73% found the advice helpful while 60% stated that it helped them communicate with their GP better. 62% of patients had taken a recommended treatment.
Headed by Professor Morice, the Hull Cough Clinic's (HCC) expertise in combining an array of diagnostics, including impedance oesophageal monitoring, non-invasive cough monitoring and cough challenge methodologies has improved diagnostic accuracy to greater than 95%. The probabilistic diagnostic algorithm developed in the HCC has been incorporated into both national (BTS) and international (ERS) guidelines.
Some case studies outlining the success of the cough clinic in Hull can be seen by following the links below:'My cough nearly cost me my job' - source bbc.co.uk (link to: http://news.bbc.co.uk/1/hi/health/6248692.stm)
'Cough find sparks treatment hope'- source bbc.co.uk (link to: http://news.bbc.co.uk/1/hi/health/8144251.stm)