Classification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report

CHEST Expert Cough Panel*, Richard S. Irwin, Cynthia L. French, Anne B. Chang, Kenneth W. Altman, Todd M. Adams, Kenneth W. Altman, Elie Azoulay, Alan F. Barker, Surinder S. Birring, Fiona Blackhall, Donald C. Bolser, Louis Philippe Boulet, Christopher Brightling, Priscilla Callahan-Lyon, Anne B. Chang, Terrie Cowley, Satoru Ebihara, Ali A. El Solh, Patricio Escalante & 31 others Stephen K. Field, Dina Fisher, Cynthia T. French, Peter Gibson, Philip Gold, Susan M. Harding, Anthony Harnden, Adam T. Hill, Richard S. Irwin, Joanne Kavanagh, Karina A. Keogh, Kefang Lai, Andrew P. Lane, Kaiser Lim, J. Mark Madison, Mark A. Malesker, Stuart Mazzone, Alex Molassoitis, M. Hassan Murad, Mangala Narasimhan, Huong Q. Nguyen, Peter Newcombe, John Oppenheimer, Marcos I. Restrepo, Mark Rosen, Bruce Rubin, Jay H. Ryu, Susan M. Tarlo, Julie Turmel, Anne E. Vertigan, Gang Wang

Research output: Contribution to journalArticle

  • 6 Citations

Abstract

Background We performed systematic reviews using the population, intervention, comparison, outcome (PICO) format to answer the following key clinical question: Are the CHEST 2006 classifications of acute, subacute and chronic cough and associated management algorithms in adults that were based on durations of cough useful? Methods We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development, and Evaluation framework. Data from the systematic reviews in conjunction with patient values and preferences and the clinical context were used to form recommendations or suggestions. Delphi methodology was used to obtain the final grading. Results With respect to acute cough (< 3 weeks), only three studies met our criteria for quality assessment, and all had a high risk of bias. As predicted by the 2006 CHEST Cough Guidelines, the most common causes were respiratory infections, most likely of viral cause, followed by exacerbations of underlying diseases such as asthma and COPD and pneumonia. The subjects resided on three continents: North America, Europe, and Asia. With respect to subacute cough (duration, 3-8 weeks), only two studies met our criteria for quality assessment, and both had a high risk of bias. As predicted by the 2006 guidelines, the most common causes were postinfectious cough and exacerbation of underlying diseases such as asthma, COPD, and upper airway cough syndrome (UACS). The subjects resided in countries in Asia. With respect to chronic cough (> 8 weeks), 11 studies met our criteria for quality assessment, and all had a high risk of bias. As predicted by the 2006 guidelines, the most common causes were UACS from rhinosinus conditions, asthma, gastroesophageal reflux disease, nonasthmatic eosinophilic bronchitis, combinations of these four conditions, and, less commonly, a variety of miscellaneous conditions and atopic cough in Asian countries. The subjects resided on four continents: North America, South America, Europe, and Asia. Conclusions Although the quality of evidence was low, the published literature since 2006 suggests that CHEST's 2006 Cough Guidelines and management algorithms for acute, subacute, and chronic cough in adults appeared useful in diagnosing and treating patients with cough around the globe. These same algorithms have been updated to reflect the advances in cough management as of 2017.

LanguageEnglish (US)
Pages196-209
Number of pages14
JournalChest
Volume153
Issue number1
DOIs
StatePublished - Jan 1 2018

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Cough
Guidelines
Patient Preference
Bronchitis
South America
Gastroesophageal Reflux
North America
Asthma
Population

Keywords

  • cough
  • evidence-based medicine
  • guidelines
  • management algorithms for acute, subacute, and chronic cough in adults

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Classification of Cough as a Symptom in Adults and Management Algorithms : CHEST Guideline and Expert Panel Report. / CHEST Expert Cough Panel*.

In: Chest, Vol. 153, No. 1, 01.01.2018, p. 196-209.

Research output: Contribution to journalArticle

@article{e4471696730a4cdf8b6ce718bd7c9ea2,
title = "Classification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report",
abstract = "Background We performed systematic reviews using the population, intervention, comparison, outcome (PICO) format to answer the following key clinical question: Are the CHEST 2006 classifications of acute, subacute and chronic cough and associated management algorithms in adults that were based on durations of cough useful? Methods We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development, and Evaluation framework. Data from the systematic reviews in conjunction with patient values and preferences and the clinical context were used to form recommendations or suggestions. Delphi methodology was used to obtain the final grading. Results With respect to acute cough (< 3 weeks), only three studies met our criteria for quality assessment, and all had a high risk of bias. As predicted by the 2006 CHEST Cough Guidelines, the most common causes were respiratory infections, most likely of viral cause, followed by exacerbations of underlying diseases such as asthma and COPD and pneumonia. The subjects resided on three continents: North America, Europe, and Asia. With respect to subacute cough (duration, 3-8 weeks), only two studies met our criteria for quality assessment, and both had a high risk of bias. As predicted by the 2006 guidelines, the most common causes were postinfectious cough and exacerbation of underlying diseases such as asthma, COPD, and upper airway cough syndrome (UACS). The subjects resided in countries in Asia. With respect to chronic cough (> 8 weeks), 11 studies met our criteria for quality assessment, and all had a high risk of bias. As predicted by the 2006 guidelines, the most common causes were UACS from rhinosinus conditions, asthma, gastroesophageal reflux disease, nonasthmatic eosinophilic bronchitis, combinations of these four conditions, and, less commonly, a variety of miscellaneous conditions and atopic cough in Asian countries. The subjects resided on four continents: North America, South America, Europe, and Asia. Conclusions Although the quality of evidence was low, the published literature since 2006 suggests that CHEST's 2006 Cough Guidelines and management algorithms for acute, subacute, and chronic cough in adults appeared useful in diagnosing and treating patients with cough around the globe. These same algorithms have been updated to reflect the advances in cough management as of 2017.",
keywords = "cough, evidence-based medicine, guidelines, management algorithms for acute, subacute, and chronic cough in adults",
author = "{CHEST Expert Cough Panel*} and Irwin, {Richard S.} and French, {Cynthia L.} and Chang, {Anne B.} and Altman, {Kenneth W.} and Adams, {Todd M.} and Altman, {Kenneth W.} and Elie Azoulay and Barker, {Alan F.} and Birring, {Surinder S.} and Fiona Blackhall and Bolser, {Donald C.} and Boulet, {Louis Philippe} and Christopher Brightling and Priscilla Callahan-Lyon and Chang, {Anne B.} and Terrie Cowley and Satoru Ebihara and {El Solh}, {Ali A.} and Patricio Escalante and Field, {Stephen K.} and Dina Fisher and French, {Cynthia T.} and Peter Gibson and Philip Gold and Harding, {Susan M.} and Anthony Harnden and Hill, {Adam T.} and Irwin, {Richard S.} and Joanne Kavanagh and Keogh, {Karina A.} and Kefang Lai and Lane, {Andrew P.} and Kaiser Lim and Madison, {J. Mark} and Malesker, {Mark A.} and Stuart Mazzone and Alex Molassoitis and Murad, {M. Hassan} and Mangala Narasimhan and Nguyen, {Huong Q.} and Peter Newcombe and John Oppenheimer and Restrepo, {Marcos I.} and Mark Rosen and Bruce Rubin and Ryu, {Jay H.} and Tarlo, {Susan M.} and Julie Turmel and Vertigan, {Anne E.} and Gang Wang",
year = "2018",
month = "1",
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doi = "10.1016/j.chest.2017.10.016",
language = "English (US)",
volume = "153",
pages = "196--209",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
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TY - JOUR

T1 - Classification of Cough as a Symptom in Adults and Management Algorithms

T2 - Chest

AU - CHEST Expert Cough Panel

AU - Irwin, Richard S.

AU - French, Cynthia L.

AU - Chang, Anne B.

AU - Altman, Kenneth W.

AU - Adams, Todd M.

AU - Altman, Kenneth W.

AU - Azoulay, Elie

AU - Barker, Alan F.

AU - Birring, Surinder S.

AU - Blackhall, Fiona

AU - Bolser, Donald C.

AU - Boulet, Louis Philippe

AU - Brightling, Christopher

AU - Callahan-Lyon, Priscilla

AU - Chang, Anne B.

AU - Cowley, Terrie

AU - Ebihara, Satoru

AU - El Solh, Ali A.

AU - Escalante, Patricio

AU - Field, Stephen K.

AU - Fisher, Dina

AU - French, Cynthia T.

AU - Gibson, Peter

AU - Gold, Philip

AU - Harding, Susan M.

AU - Harnden, Anthony

AU - Hill, Adam T.

AU - Irwin, Richard S.

AU - Kavanagh, Joanne

AU - Keogh, Karina A.

AU - Lai, Kefang

AU - Lane, Andrew P.

AU - Lim, Kaiser

AU - Madison, J. Mark

AU - Malesker, Mark A.

AU - Mazzone, Stuart

AU - Molassoitis, Alex

AU - Murad, M. Hassan

AU - Narasimhan, Mangala

AU - Nguyen, Huong Q.

AU - Newcombe, Peter

AU - Oppenheimer, John

AU - Restrepo, Marcos I.

AU - Rosen, Mark

AU - Rubin, Bruce

AU - Ryu, Jay H.

AU - Tarlo, Susan M.

AU - Turmel, Julie

AU - Vertigan, Anne E.

AU - Wang, Gang

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background We performed systematic reviews using the population, intervention, comparison, outcome (PICO) format to answer the following key clinical question: Are the CHEST 2006 classifications of acute, subacute and chronic cough and associated management algorithms in adults that were based on durations of cough useful? Methods We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development, and Evaluation framework. Data from the systematic reviews in conjunction with patient values and preferences and the clinical context were used to form recommendations or suggestions. Delphi methodology was used to obtain the final grading. Results With respect to acute cough (< 3 weeks), only three studies met our criteria for quality assessment, and all had a high risk of bias. As predicted by the 2006 CHEST Cough Guidelines, the most common causes were respiratory infections, most likely of viral cause, followed by exacerbations of underlying diseases such as asthma and COPD and pneumonia. The subjects resided on three continents: North America, Europe, and Asia. With respect to subacute cough (duration, 3-8 weeks), only two studies met our criteria for quality assessment, and both had a high risk of bias. As predicted by the 2006 guidelines, the most common causes were postinfectious cough and exacerbation of underlying diseases such as asthma, COPD, and upper airway cough syndrome (UACS). The subjects resided in countries in Asia. With respect to chronic cough (> 8 weeks), 11 studies met our criteria for quality assessment, and all had a high risk of bias. As predicted by the 2006 guidelines, the most common causes were UACS from rhinosinus conditions, asthma, gastroesophageal reflux disease, nonasthmatic eosinophilic bronchitis, combinations of these four conditions, and, less commonly, a variety of miscellaneous conditions and atopic cough in Asian countries. The subjects resided on four continents: North America, South America, Europe, and Asia. Conclusions Although the quality of evidence was low, the published literature since 2006 suggests that CHEST's 2006 Cough Guidelines and management algorithms for acute, subacute, and chronic cough in adults appeared useful in diagnosing and treating patients with cough around the globe. These same algorithms have been updated to reflect the advances in cough management as of 2017.

AB - Background We performed systematic reviews using the population, intervention, comparison, outcome (PICO) format to answer the following key clinical question: Are the CHEST 2006 classifications of acute, subacute and chronic cough and associated management algorithms in adults that were based on durations of cough useful? Methods We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development, and Evaluation framework. Data from the systematic reviews in conjunction with patient values and preferences and the clinical context were used to form recommendations or suggestions. Delphi methodology was used to obtain the final grading. Results With respect to acute cough (< 3 weeks), only three studies met our criteria for quality assessment, and all had a high risk of bias. As predicted by the 2006 CHEST Cough Guidelines, the most common causes were respiratory infections, most likely of viral cause, followed by exacerbations of underlying diseases such as asthma and COPD and pneumonia. The subjects resided on three continents: North America, Europe, and Asia. With respect to subacute cough (duration, 3-8 weeks), only two studies met our criteria for quality assessment, and both had a high risk of bias. As predicted by the 2006 guidelines, the most common causes were postinfectious cough and exacerbation of underlying diseases such as asthma, COPD, and upper airway cough syndrome (UACS). The subjects resided in countries in Asia. With respect to chronic cough (> 8 weeks), 11 studies met our criteria for quality assessment, and all had a high risk of bias. As predicted by the 2006 guidelines, the most common causes were UACS from rhinosinus conditions, asthma, gastroesophageal reflux disease, nonasthmatic eosinophilic bronchitis, combinations of these four conditions, and, less commonly, a variety of miscellaneous conditions and atopic cough in Asian countries. The subjects resided on four continents: North America, South America, Europe, and Asia. Conclusions Although the quality of evidence was low, the published literature since 2006 suggests that CHEST's 2006 Cough Guidelines and management algorithms for acute, subacute, and chronic cough in adults appeared useful in diagnosing and treating patients with cough around the globe. These same algorithms have been updated to reflect the advances in cough management as of 2017.

KW - cough

KW - evidence-based medicine

KW - guidelines

KW - management algorithms for acute, subacute, and chronic cough in adults

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