Clinical benefit of sequential three-step empirical therapy in the management of chronic cough

Background and objective: A prospective study was conducted to investigate the efficacy of empirical therapy in the management of chronic cough. Methods: A three‐step empirical therapy protocol was used to treat patients who had a chronic cough and a normal CXR and normal lung function testing. In step one antihistamine decongestants plus bronchodilators were taken, corticosteroids in the second step, and a combination of a proton pump inhibitor and a prokinetic agent in the third step. Cough symptom scores were recorded before and after each step in the protocol. Results: There were 102 patients recruited; mean age 49 ± 16 years and with a history of cough of between 2 and 120 months at presentation. The cough resolved in 67.6% ( n = 69) of the patients after the first‐step therapy; in a further 12.7% (13) after the second‐step therapy, and in another 7.8% (8) after the third‐step of the treatment protocol. In three patients cough improved after the first‐step of therapy but only achieved complete resolution when this treatment was combined with the third‐step therapy. Overall, the three‐step empirical therapy was successful in 88.2% ( n = 90) of the patients. Cough symptom scores decreased from 3.30 ± 0.75 to 0.30 ± 0.97 ( P < 0.001). The mean duration of treatment was 2.70 ± 1.52 weeks (range 1–12). Cough was controlled in <4 weeks in 79.4% ( n = 81) of patients. Conclusions: Three‐step empirical therapy seemed to be useful in most patients and has practical application in the management of chronic cough.