Evaluation of chronic cough in chemical chronic bronchitis patients.

BACKGROUND

: Coughing is one of the chronic respiratory symptoms of patients exposed to sulfur mustard (SM) used against Iranian combatants and civilians by Iraq during the Iran-Iraq war, between 1983 and 1989. This study carried out on SM exposed patients who referred to our clinic because of exacerbation of chronic cough.

METHOD

: Fifty male SM injured patient in the age range of 21-79 years, all of them having chronic bronchitis and were suffering from chronic cough (>3 weeks) were evaluated. After history taking and performing physical examination our diagnostic evaluation included chest X-ray, pulmonary function test (PFT), para nasal computerized tomography, esophageal endoscopy and fiber optic bronchoscopy.

RESULTS

: Apart from having chronic bronchitis as a constant disease in all patients, the other main causative factors behind chronic cough were bronchospasm, post-nasal drip syndrome (PNDS), and gastro esophageal reflux disease (GERD), which accounted for 66%, 46% and 44% of chronic cough of the patients, respectively. A single cause for chronic cough was found in 4 patients (8%), 2 causes in 17 patients (34%), 3 causes in 23 patients (46%) and 4 causes in 6 patients (12%).

CONCLUSION

: Since a high majority of the patients had more than a single cause for chronic cough, multiplicity of causes of chronic cough in a patient is indicative for evaluation of possible exposure to chemical fumes, especially SM. Because of high prevalence of chronic bronchitis (100%) and bronchospasm (66%) among our study group we conclude that they should be considered at first, before assessment of other causes.