Chronic cough

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7397.1036 (Published 10 May 2003) Cite this as: BMJ 2003;326:1036

Article is not consistent with WHO initiative on rhinitis and asthma

  1. Mike Thomas, General Practice Airways Group clinical research fellow (mikethomas@doctors.org.uk),
  2. David Price, General Practice Airways Group professor of primary care respiratory medicine
  1. Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen AB25 2AY
  2. Northfield Medical Centre, Birmingham B31 1QT
  3. Royal College of General Practitioners Research Unit, Birmingham B17 9DB
  4. South West London Strategic Health Authority, London SW19 3RG
  5. Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayawardenapure, Sri Lanka

    EDITOR—The discussion on rhinitis in the article on chronic cough in the 10-minute consultation series seems inconsistent with the World Health Organization's recent initiative on allergic rhinitis and its impact on asthma. 1 2

    The classification of rhinitis used (“perennial” and “seasonal”) has been superseded by the subdivisions “intermittent” and “persistent” rhinitis, graded “mild,” “moderate,” or “severe,” which is believed to have advantages in understanding the condition and in guiding treatment. The initiative lists pharmacological options as oral or local decongestants, oral or local antihistamines, intranasal corticosteroids, and local anticholinergics, with other options including systemic corticosteroids, local chromones and antileucotrienes.

    In mild intermittent rhinitis, antihistamines are recommended as first line treatment, with the addition of nasal corticosteroids or chromones for moderate to severe intermittent disease. Nasal steroids are recommended for earlier use in persistent disease, with the addition of ipratropium if rhinorrhoea is prominent. This algorithm is different from that presented in the article.

    The article is also not clear on what is meant by “non-allergic rhinitis” or how general practitioners are to differentiate it from allergic rhinitis other than by skin prick or radioallergosorbent testing to aeroallergens. These …

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