Scant evidence for many risk factors for chronic cough
Asthma, persistent smoking and lower education are the main risk factors related to chronic cough in adults, according to a systematic review and meta-analysis.
The Australian research, led by the Allergy and Lung Health Unit in the University of Melbourne’s School of Population and Global Health, identified 26 longitudinal observational studies assessing risk factors for chronic cough, with and without phlegm.
It found people with doctor-diagnosed asthma had an adjusted OR of 3.01 for chronic cough and persistent smokers an aOR of 1.81.
Obesity, COPD, GORD, obstructive airways disease, chronic pain and snoring were all found to be associated with increased risk of chronic cough but only in one study each.
There was also a single study showing that high intakes of non-starch polysaccharides, fruit and total soya isoflavones, and exclusive breastfeeding for more than 4 months were associated with lower odds of chronic cough.
“Our review has highlighted the paucity of high-quality data directly relating chronic cough to supposed risk factors.” the researchers said.
“Ideally, future studies would use both the chronic bronchitis definition (cough with phlegm for ≥3 months/2 years) as well as the chronic cough definition from recent guidelines (cough ≥ 8 weeks) to be able to effectively undertake meta-analysis and tease out the complexities in this evolving body of evidence.”
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Medicare claims repaid by nurse practitioner
Nurse practitioners have not escaped the scrutiny of the Medicare claims watchdog, the Professional Services Review (PSR), with one practitioner receiving a reprimand and agreeing to repay $80,000 to Medicare for inappropriate claims for long consultations.
The PSR’s update for September 2021 reports an investigation it mounted into claims made by an un-named nurse practitioner who was the highest ranked provider nationally of MBS item 82215.
The item covers consultations over 40 minutes for the purposes of taking an extensive history; undertaking clinical examination; arranging necessary investigations; implementing a management plan and providing appropriate preventive health care,
According to the PSR, the investigation revealed concerns that the MBS requirements were not always met, “as the clinical input and complexity of the service was not consistent with at least 40 minutes of clinical input being provided, as required by the MBS item descriptor and the practitioner’s records were not always adequate or contemporaneous.”
The PSR also had concerns that the nurse practitioner’s handwritten records were extremely difficult to read and did not reflect that nursing processes were followed.
“In some cases no record for the date of service could be identified in the patient record,” it noted.
The nurse practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS item 82215, received a reprimand from the PSR, agreed to repay $80,000 and was disqualified from providing MBS item 82215 for a period of 12 months.
CPAP reduces intubation/death in COVID-19: guidelines
The National COVID-19 Clinical Evidence Taskforce has recommended CPAP therapy for COVID-19 patients with persistent hypoxaemia (defined as requiring an FiO2 ≥ 0.4 to maintain SpO2 in their target range).
The recommendation is based on results from the Recovery-Respiratory Support study which found CPAP, compared to conventional oxygen therapy, reduced the composite outcome of intubation or death within 30 days of randomisation in hospitalised adults with acute respiratory failure due to COVID-19.
“Adjust positive end-expiratory pressure as required, most patients require pressures of 10 to 12 cm. Excessive pressures may increase the risk of pneumothorax. Adjust oxygen to maintain SpO2 in the target range, FiO2 0.4 to 0.6,” the Australian guidelines for the clinical care of people with COVID-19 said.
The Taskforce said patients requiring CPAP for COVID-19 pneumonia are at high risk of further deterioration, requiring intubation and mechanical ventilation.
“Liaise with ICU and monitor closely for deterioration.”
“If CPAP is not available or not tolerated, consider HFNO as an alternative using the same safety parameters as CPAP.”