What are the presentation and treatment options?

From the Guidelines

The presentation of chronic upper airway cough syndrome (UACS) secondary to rhinosinus diseases typically involves a thorough assessment of symptoms, signs, and clinical features, while treatment options are somewhat dependent on the specific subcategory of disease that is present, and may include avoidance, treatment to block or reduce inflammation and secretions, treatment of infection, and correction of structural alterations, as recommended by the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines 1. When a patient presents with symptoms of UACS-induced cough, healthcare providers should first conduct a thorough assessment including history taking, physical examination, and appropriate diagnostic tests to establish a diagnosis.

Key Considerations

• The treatment options for UACS-induced cough are dependent on the specific subcategory of disease that is present, and may include medications, surgical interventions, or lifestyle modifications.
• The ACCP guidelines recommend that treatment options be classified into avoidance, treatment to block or reduce inflammation and secretions, treatment of infection, and correction of structural alterations 1.
• Effective treatment requires monitoring for response and potential side effects, with adjustments made as needed, and the goal is to alleviate symptoms, address the underlying cause when possible, prevent complications, and improve the patient's quality of life and functional status.

Treatment Approach

• The treatment approach for UACS-induced cough should be tailored to the specific condition and may include medications such as those that reduce inflammation and secretions, or treat infection.
• The choice of treatment depends on factors such as the severity of the condition, patient characteristics (age, comorbidities, allergies), and evidence-based guidelines.
• Clinicians should clearly explain all potential treatment options, the specific biomarker testing needed to determine the appropriateness of those treatment options, the potential outcomes of each, and possible adverse effects (AEs) so that patients understand the benefits and drawbacks of each option and can make an informed decision 1.

From the FDA Drug Label

2.1 Dosage and Administration Overview Administer oseltamivir phosphate for oral suspension for the treatment of influenza in patients 2 weeks of age or older [see Dosage and Administration (2.2)] or for prophylaxis of influenza in patients 1 year and older [see Dosage and Administration (2.3)] using: Oseltamivir phosphate for oral suspension (supplied as a powder). This is the preferred formulation (6 mg per mL) for patients who cannot swallow capsules. Prior to use, the supplied oseltamivir phosphate for oral suspension powder must be constituted with water by the pharmacist to produce the oral suspension [see Dosage and Administration (2.5)]. The oral suspension may be taken with or without food; however, tolerability may be enhanced if oseltamivir phosphate for oral suspension is taken with food. Adjust the oseltamivir phosphate for oral suspension dosage in patients with moderate or severe renal impairment [see Dosage and Administration (2.4)].

The presentation of oseltamivir phosphate for oral suspension is a powder that must be constituted with water by a pharmacist to produce an oral suspension. The treatment of influenza with oseltamivir phosphate for oral suspension involves administering the oral suspension to patients 2 weeks of age or older, with the dosage adjusted based on the patient's age and renal function 2.

From the Research

Presentation of Infections

• The presentation of infections can vary depending on the type of infection and the causative organism 3, 4.
• Ceftriaxone has been effective in treating a range of infections, including urinary tract infections, lower respiratory tract infections, skin and soft tissue infections, and bone and joint infections 3, 4.
• The drug has also been used to treat more serious infections, such as meningitis and septicemia, and has been shown to be effective in patients with multidrug-resistant Gram-negative bacteria 3, 4.

Treatment of Infections

• Ceftriaxone is typically administered intravenously or intramuscularly, and has a broad spectrum of activity against Gram-positive and Gram-negative aerobic and anaerobic bacteria 3, 4.
• The drug has been shown to be effective in treating infections caused by a range of organisms, including Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria spp. 3, 4.
• Ceftriaxone has also been used in combination with other antibiotics, such as aminoglycosides, to treat more serious infections 4.

Contextual Factors in Clinical Reasoning

• Contextual factors, such as patient demographics and medical history, can influence clinical reasoning and diagnosis 5.
• The presence of distracting contextual factors can lead to errors in diagnosis and treatment 5.
• Clinicians must consider these factors when making diagnostic and treatment decisions 5, 6.

Generalisability and Applicability of Study Results

• The generalisability and applicability of study results can be limited by factors such as patient population and study design 6.
• Clinicians must carefully consider these factors when applying study results to individual patients 6.
• The use of systematic review and meta-analysis can help to increase the generalisability and applicability of study results 7.