Unexplained chronic cough treatment subject of updated evidence-based guideline

Persistent, unexplained cough is a significant health issue that occurs in up to 5-10 percent of patients seeking medical assistance for chronic cough. Patients experience significant quality of life impairment with chronic cough lasting for many months or years, despite attempts at treatment. In this latest evidence-based guideline from the American College of Chest Physicians, experts provide six recommendations for appropriate treatment of patients with unexplained chronic cough, including the use of speech pathology based cough suppression as a treatment option.

“This guideline chapter, another from CHEST living guidelines, provides the most up-to-date treatment options for patients living with unexplained chronic cough. The guideline presents suggestions for diagnosis and treatment based on the best available evidence and identifies gaps in our knowledge and areas for future research,” said Richard S. Irwin, MD, Master FCCP, and Diagnosis and Management of Cough: CHEST Evidence-Based Clinical Practice Guidelines Chair.

To date, the updated guideline has been endorsed by the American Academy of Otolaryngology- Head and Neck Surgery, American Association for Respiratory Care, American Thoracic Society, Irish Thoracic Society, and Lung Foundation Australia.

The complete guideline chapter is free to view in the Online First section of the journal CHEST: http://bit.ly/1Ri93FS

About CHEST Living Guidelines Living guidelines are systematically developed, evidence-based, and continually updated recommendations for the diagnosis and management of medical conditions. These guidelines are intended to inform both healthcare providers and patients in making educated clinical decisions.

What is chronic cough?

Chronic cough is a cough that persists over time. Chronic cough is not a disease in itself, but rather a symptom of an underlying condition. Chronic cough is a common problem and the reason for many doctor visits.

Some common causes of chronic cough include asthma, allergic rhinitis, sinus problems (for example sinus infection), and esophageal reflux of stomach contents. In rare cases, chronic cough may be the result of inhaling foreign objects into the lungs (usually in children). It is important to see a doctor who may order a chest X-ray if a chronic cough is present. The following are common causes of chronic coughing.
- Cigarette smoking
- Asthma
- Gastroesophageal reflux disease (GERD)
- Sinus problems and postnasal drip
- Infections such as bronchitis or pneumonia
- Chronic cough in children

Unexplained chronic cough treatment subject of updated evidence-based guideline American College of Chest Physicians (CHEST), publisher of the journal CHEST, is the global leader in advancing best patient outcomes through innovative chest medicine education, clinical research, and team-based care. Its mission is to champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research. CHEST serves as an essential connection to clinical knowledge and resources for its 18,700 members from around the world who provide patient care in pulmonary, critical care, and sleep medicine. CHEST Enterprises, Inc, a wholly owned subsidiary of CHEST, provides innovative education for health-care professionals and industry partners to advance best patient outcomes.

For more information, visit chestnet.org.

The conventional definition of a disease or condition being unexplained, previously referred to as idiopathic, is usually that no etiologic explanation can be found after an appropriate and complete diagnostic evaluation. The most difficult aspect of this definition is to define what is, in fact, an “appropriate” or “complete” evaluation. There is a considerable amount of variation among published studies as to the percentage of patients seen with chronic cough in whom no diagnosis can be made. The percentages range from zero in a number of studies to as high as 33% in one study by Puolijoki and Lahdensuo. Based on the information described in the latter article, however, in the majority of the cases labeled as unexplained, a likely diagnosis was actually present.

The diagnosis of unexplained (idiopathic) cough is a diagnosis of exclusion. It should not be made until a thorough diagnostic evaluation is performed, specific and appropriate treatment (according to the management protocols that have performed the best in the literature) has been tried and has failed, and uncommon causes have been ruled out.

Level of evidence, expert opinion; benefit, substantial; grade of recommendation, E/A


Kristi Bruno
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American College of Chest Physicians

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