Cough in the Athlete: CHEST Guideline and Expert Panel Report

Louis Philippe Boulet, Julie Turmel, Richard S. Irwin, Kenneth W. Altman, Alan Barker, Surinder S. Birring, Fiona Blackhall, Donald C. Bolser, Louis Philippe Boulet, Sidney S. Braman, Christopher Brightling, Priscilla Callahan-Lyon, Anne B. Chang, Terrie Cowley, Paul Davenport, Satoru Ebihara, Ali A. El Solh, Patricio Escalante, Anthony Feinstein, Stephen K. FieldDina Fisher, Cynthia T. French, Peter Gibson, Philip Gold, Cameron Grant, Susan M. Harding, Anthony Harnden, Adam T. Hill, Richard S. Irwin, Peter J. Kahrilas, Karina A. Keogh, Kefang Lai, Andrew P. Lane, Kaiser Lim, Mark A. Malesker, Peter Mazzone, Lorcan McGarvey, M. Hassan Murad, Peter Newcombe, Huong Q. Nguyen, John Oppenheimer, Mark Rosen, Bruce Rubin, Jay H. Ryu, Jaclyn Smith, Susan M. Tarlo, Anne E. Vertigan, Gang Wang, Miles Weinberger, Kelly Weir

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background Cough is a common symptom experienced by athletes, particularly after exercise. We performed a systematic review to assess the following in this population: (1) the main causes of acute and recurrent cough, either exercise-induced or not, (2) how cough is assessed, and (3) how cough is treated in this population. From the systematic review, suggestions for management were developed. Methods This review was performed according to the CHEST methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework until April 2015. To be included, studies had to meet the following criteria: participants had to be athletes and adults and adolescents aged ≥ 12 years and had to complain of cough, regardless of its duration or relationship to exercise. The Expert Cough Panel based their suggestions on the data extracted from the review and final grading by consensus according to a Delphi process. Results Only 60 reports fulfilled the inclusion criteria, and the results of our analysis revealed only low-quality evidence on the causes of cough and how to assess and treat cough specifically in athletes. Although there was no formal evaluation of causes of cough in the athletic population, the most common causes reported were asthma, exercise-induced bronchoconstriction, respiratory tract infection (RTI), upper airway cough syndrome (UACS) (mostly from rhinitis), and environmental exposures. Cough was also reported to be related to exercise-induced vocal cord dysfunction among a variety of less common causes. Although gastroesophageal reflux disease (GERD) is frequent in athletes, we found no publication on cough and GERD in this population. Assessment of the causes of cough was performed mainly with bronchoprovocation tests and suspected disease-specific investigations. The evidence to guide treatment of cough in the athlete was weak or nonexistent, depending on the cause. As data on cough in athletes were hidden in a set of other data (respiratory symptoms), evidence tables were difficult to produce and were done only for cough treatment in athletes. Conclusions The causes of cough in the athlete appear to differ slightly from those in the general population. It is often associated with environmental exposures related to the sport training environment and occurs predominantly following intense exercise. Clinical history and specific investigations should allow identification of the cause of cough as well as targeting of the treatment. Until management studies have been performed in the athlete, current guidelines that exist for the general population should be applied for the evaluation and treatment of cough in the athlete, taking into account specific training context and anti-doping regulations.

Original languageEnglish (US)
Pages (from-to)441-454
Number of pages14
JournalChest
Volume151
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Cough
Athletes
Guidelines
Exercise
Population
Environmental Exposure
Gastroesophageal Reflux
Sports
Vocal Cord Dysfunction
Exercise-Induced Asthma
Bronchoconstriction
Therapeutics
Rhinitis
Respiratory Tract Infections

Keywords

  • athletes
  • cough
  • evidence-based medicine
  • exercise
  • guidelines
  • sports

ASJC Scopus subject areas

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

Cite this

Boulet, L. P., Turmel, J., Irwin, R. S., Altman, K. W., Barker, A., Birring, S. S., ... Weir, K. (2017). Cough in the Athlete: CHEST Guideline and Expert Panel Report. Chest, 151(2), 441-454. https://doi.org/10.1016/j.chest.2016.10.054

Cough in the Athlete : CHEST Guideline and Expert Panel Report. / Boulet, Louis Philippe; Turmel, Julie; Irwin, Richard S.; Altman, Kenneth W.; Barker, Alan; Birring, Surinder S.; Blackhall, Fiona; Bolser, Donald C.; Boulet, Louis Philippe; Braman, Sidney S.; Brightling, Christopher; Callahan-Lyon, Priscilla; Chang, Anne B.; Cowley, Terrie; Davenport, Paul; Ebihara, Satoru; El Solh, Ali A.; Escalante, Patricio; Feinstein, Anthony; Field, Stephen K.; Fisher, Dina; French, Cynthia T.; Gibson, Peter; Gold, Philip; Grant, Cameron; Harding, Susan M.; Harnden, Anthony; Hill, Adam T.; Irwin, Richard S.; Kahrilas, Peter J.; Keogh, Karina A.; Lai, Kefang; Lane, Andrew P.; Lim, Kaiser; Malesker, Mark A.; Mazzone, Peter; McGarvey, Lorcan; Murad, M. Hassan; Newcombe, Peter; Nguyen, Huong Q.; Oppenheimer, John; Rosen, Mark; Rubin, Bruce; Ryu, Jay H.; Smith, Jaclyn; Tarlo, Susan M.; Vertigan, Anne E.; Wang, Gang; Weinberger, Miles; Weir, Kelly.

In: Chest, Vol. 151, No. 2, 01.02.2017, p. 441-454.

Research output: Contribution to journalArticle

Boulet, LP, Turmel, J, Irwin, RS, Altman, KW, Barker, A, Birring, SS, Blackhall, F, Bolser, DC, Boulet, LP, Braman, SS, Brightling, C, Callahan-Lyon, P, Chang, AB, Cowley, T, Davenport, P, Ebihara, S, El Solh, AA, Escalante, P, Feinstein, A, Field, SK, Fisher, D, French, CT, Gibson, P, Gold, P, Grant, C, Harding, SM, Harnden, A, Hill, AT, Irwin, RS, Kahrilas, PJ, Keogh, KA, Lai, K, Lane, AP, Lim, K, Malesker, MA, Mazzone, P, McGarvey, L, Murad, MH, Newcombe, P, Nguyen, HQ, Oppenheimer, J, Rosen, M, Rubin, B, Ryu, JH, Smith, J, Tarlo, SM, Vertigan, AE, Wang, G, Weinberger, M & Weir, K 2017, 'Cough in the Athlete: CHEST Guideline and Expert Panel Report', Chest, vol. 151, no. 2, pp. 441-454. https://doi.org/10.1016/j.chest.2016.10.054
Boulet LP, Turmel J, Irwin RS, Altman KW, Barker A, Birring SS et al. Cough in the Athlete: CHEST Guideline and Expert Panel Report. Chest. 2017 Feb 1;151(2):441-454. https://doi.org/10.1016/j.chest.2016.10.054
Boulet, Louis Philippe ; Turmel, Julie ; Irwin, Richard S. ; Altman, Kenneth W. ; Barker, Alan ; Birring, Surinder S. ; Blackhall, Fiona ; Bolser, Donald C. ; Boulet, Louis Philippe ; Braman, Sidney S. ; Brightling, Christopher ; Callahan-Lyon, Priscilla ; Chang, Anne B. ; Cowley, Terrie ; Davenport, Paul ; Ebihara, Satoru ; El Solh, Ali A. ; Escalante, Patricio ; Feinstein, Anthony ; Field, Stephen K. ; Fisher, Dina ; French, Cynthia T. ; Gibson, Peter ; Gold, Philip ; Grant, Cameron ; Harding, Susan M. ; Harnden, Anthony ; Hill, Adam T. ; Irwin, Richard S. ; Kahrilas, Peter J. ; Keogh, Karina A. ; Lai, Kefang ; Lane, Andrew P. ; Lim, Kaiser ; Malesker, Mark A. ; Mazzone, Peter ; McGarvey, Lorcan ; Murad, M. Hassan ; Newcombe, Peter ; Nguyen, Huong Q. ; Oppenheimer, John ; Rosen, Mark ; Rubin, Bruce ; Ryu, Jay H. ; Smith, Jaclyn ; Tarlo, Susan M. ; Vertigan, Anne E. ; Wang, Gang ; Weinberger, Miles ; Weir, Kelly. / Cough in the Athlete : CHEST Guideline and Expert Panel Report. In: Chest. 2017 ; Vol. 151, No. 2. pp. 441-454.
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abstract = "Background Cough is a common symptom experienced by athletes, particularly after exercise. We performed a systematic review to assess the following in this population: (1) the main causes of acute and recurrent cough, either exercise-induced or not, (2) how cough is assessed, and (3) how cough is treated in this population. From the systematic review, suggestions for management were developed. Methods This review was performed according to the CHEST methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework until April 2015. To be included, studies had to meet the following criteria: participants had to be athletes and adults and adolescents aged ≥ 12 years and had to complain of cough, regardless of its duration or relationship to exercise. The Expert Cough Panel based their suggestions on the data extracted from the review and final grading by consensus according to a Delphi process. Results Only 60 reports fulfilled the inclusion criteria, and the results of our analysis revealed only low-quality evidence on the causes of cough and how to assess and treat cough specifically in athletes. Although there was no formal evaluation of causes of cough in the athletic population, the most common causes reported were asthma, exercise-induced bronchoconstriction, respiratory tract infection (RTI), upper airway cough syndrome (UACS) (mostly from rhinitis), and environmental exposures. Cough was also reported to be related to exercise-induced vocal cord dysfunction among a variety of less common causes. Although gastroesophageal reflux disease (GERD) is frequent in athletes, we found no publication on cough and GERD in this population. Assessment of the causes of cough was performed mainly with bronchoprovocation tests and suspected disease-specific investigations. The evidence to guide treatment of cough in the athlete was weak or nonexistent, depending on the cause. As data on cough in athletes were hidden in a set of other data (respiratory symptoms), evidence tables were difficult to produce and were done only for cough treatment in athletes. Conclusions The causes of cough in the athlete appear to differ slightly from those in the general population. It is often associated with environmental exposures related to the sport training environment and occurs predominantly following intense exercise. Clinical history and specific investigations should allow identification of the cause of cough as well as targeting of the treatment. Until management studies have been performed in the athlete, current guidelines that exist for the general population should be applied for the evaluation and treatment of cough in the athlete, taking into account specific training context and anti-doping regulations.",
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T1 - Cough in the Athlete

T2 - CHEST Guideline and Expert Panel Report

AU - Boulet, Louis Philippe

AU - Turmel, Julie

AU - Irwin, Richard S.

AU - Altman, Kenneth W.

AU - Barker, Alan

AU - Birring, Surinder S.

AU - Blackhall, Fiona

AU - Bolser, Donald C.

AU - Boulet, Louis Philippe

AU - Braman, Sidney S.

AU - Brightling, Christopher

AU - Callahan-Lyon, Priscilla

AU - Chang, Anne B.

AU - Cowley, Terrie

AU - Davenport, Paul

AU - Ebihara, Satoru

AU - El Solh, Ali A.

AU - Escalante, Patricio

AU - Feinstein, Anthony

AU - Field, Stephen K.

AU - Fisher, Dina

AU - French, Cynthia T.

AU - Gibson, Peter

AU - Gold, Philip

AU - Grant, Cameron

AU - Harding, Susan M.

AU - Harnden, Anthony

AU - Hill, Adam T.

AU - Irwin, Richard S.

AU - Kahrilas, Peter J.

AU - Keogh, Karina A.

AU - Lai, Kefang

AU - Lane, Andrew P.

AU - Lim, Kaiser

AU - Malesker, Mark A.

AU - Mazzone, Peter

AU - McGarvey, Lorcan

AU - Murad, M. Hassan

AU - Newcombe, Peter

AU - Nguyen, Huong Q.

AU - Oppenheimer, John

AU - Rosen, Mark

AU - Rubin, Bruce

AU - Ryu, Jay H.

AU - Smith, Jaclyn

AU - Tarlo, Susan M.

AU - Vertigan, Anne E.

AU - Wang, Gang

AU - Weinberger, Miles

AU - Weir, Kelly

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background Cough is a common symptom experienced by athletes, particularly after exercise. We performed a systematic review to assess the following in this population: (1) the main causes of acute and recurrent cough, either exercise-induced or not, (2) how cough is assessed, and (3) how cough is treated in this population. From the systematic review, suggestions for management were developed. Methods This review was performed according to the CHEST methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework until April 2015. To be included, studies had to meet the following criteria: participants had to be athletes and adults and adolescents aged ≥ 12 years and had to complain of cough, regardless of its duration or relationship to exercise. The Expert Cough Panel based their suggestions on the data extracted from the review and final grading by consensus according to a Delphi process. Results Only 60 reports fulfilled the inclusion criteria, and the results of our analysis revealed only low-quality evidence on the causes of cough and how to assess and treat cough specifically in athletes. Although there was no formal evaluation of causes of cough in the athletic population, the most common causes reported were asthma, exercise-induced bronchoconstriction, respiratory tract infection (RTI), upper airway cough syndrome (UACS) (mostly from rhinitis), and environmental exposures. Cough was also reported to be related to exercise-induced vocal cord dysfunction among a variety of less common causes. Although gastroesophageal reflux disease (GERD) is frequent in athletes, we found no publication on cough and GERD in this population. Assessment of the causes of cough was performed mainly with bronchoprovocation tests and suspected disease-specific investigations. The evidence to guide treatment of cough in the athlete was weak or nonexistent, depending on the cause. As data on cough in athletes were hidden in a set of other data (respiratory symptoms), evidence tables were difficult to produce and were done only for cough treatment in athletes. Conclusions The causes of cough in the athlete appear to differ slightly from those in the general population. It is often associated with environmental exposures related to the sport training environment and occurs predominantly following intense exercise. Clinical history and specific investigations should allow identification of the cause of cough as well as targeting of the treatment. Until management studies have been performed in the athlete, current guidelines that exist for the general population should be applied for the evaluation and treatment of cough in the athlete, taking into account specific training context and anti-doping regulations.

AB - Background Cough is a common symptom experienced by athletes, particularly after exercise. We performed a systematic review to assess the following in this population: (1) the main causes of acute and recurrent cough, either exercise-induced or not, (2) how cough is assessed, and (3) how cough is treated in this population. From the systematic review, suggestions for management were developed. Methods This review was performed according to the CHEST methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework until April 2015. To be included, studies had to meet the following criteria: participants had to be athletes and adults and adolescents aged ≥ 12 years and had to complain of cough, regardless of its duration or relationship to exercise. The Expert Cough Panel based their suggestions on the data extracted from the review and final grading by consensus according to a Delphi process. Results Only 60 reports fulfilled the inclusion criteria, and the results of our analysis revealed only low-quality evidence on the causes of cough and how to assess and treat cough specifically in athletes. Although there was no formal evaluation of causes of cough in the athletic population, the most common causes reported were asthma, exercise-induced bronchoconstriction, respiratory tract infection (RTI), upper airway cough syndrome (UACS) (mostly from rhinitis), and environmental exposures. Cough was also reported to be related to exercise-induced vocal cord dysfunction among a variety of less common causes. Although gastroesophageal reflux disease (GERD) is frequent in athletes, we found no publication on cough and GERD in this population. Assessment of the causes of cough was performed mainly with bronchoprovocation tests and suspected disease-specific investigations. The evidence to guide treatment of cough in the athlete was weak or nonexistent, depending on the cause. As data on cough in athletes were hidden in a set of other data (respiratory symptoms), evidence tables were difficult to produce and were done only for cough treatment in athletes. Conclusions The causes of cough in the athlete appear to differ slightly from those in the general population. It is often associated with environmental exposures related to the sport training environment and occurs predominantly following intense exercise. Clinical history and specific investigations should allow identification of the cause of cough as well as targeting of the treatment. Until management studies have been performed in the athlete, current guidelines that exist for the general population should be applied for the evaluation and treatment of cough in the athlete, taking into account specific training context and anti-doping regulations.

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KW - evidence-based medicine

KW - exercise

KW - guidelines

KW - sports

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