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Speich et al’s article1 covers many important aspects about subacute cough, which occupies a significant amount of time in general practice, both quantitatively and qualitatively. There was no mention or analysis of the important and under-diagnosed diagnosis of pertussis which does not necessarily present with the classic “whoop”, especially in adults.2
I recall the pertussis outbreak in 2012, when a practice’s significant event described how a clinician acquired a persistent low-key spasmodic cough “that did not go away” and subsequent serology confirmed the diagnosis of pertussis. During the following few months, the practice’s diagnostic rate of pertussis increased sharply, as did the number of telephone calls from the local microbiology department asking for justification for each individual pertussis titre request.
I suggest that all trials, systematic reviews and meta-analyses about sub-acute and persistent cough need to be explicit about how pertussis is included or excluded.
Clinicians need to be mindful of the possibility of pertussis in all individuals with a diagnosis of sub-acute cough including their colleagues.
References
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1. Speich B, Thomer A, Aghlmandi S et al. Treatments for subacute cough in primary care: systematic review and meta-analyses of randomised clinical trials. Br J Gen Pract 2018;...Competing Interests: None declared.