Classification of Cough as a Symptom in Adults and Management Algorithms

CHEST Guideline and Expert Panel Report

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, Terrie Cowley, Satoru Ebihara, Ali A. El Solh, Patricio Escalante, Stephen K. Field, Dina Fisher & 33 others 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, Miles Weinberger, on behalf of the, CHEST Expert Cough Panel*, CHEST Expert Cough Panel*

    Research output: Contribution to journalArticleResearchpeer-review

    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.

    Original languageEnglish
    Pages (from-to)196-209
    Number of pages14
    JournalChest
    Volume153
    Issue number1
    DOIs
    Publication statusPublished - Jan 2018

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

    Cite this

    Irwin, R. S., French, C. L., Chang, A. B., Altman, K. W., Adams, T. M., Altman, K. W., ... CHEST Expert Cough Panel* (2018). Classification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report. Chest, 153(1), 196-209. https://doi.org/10.1016/j.chest.2017.10.016
    Irwin, Richard S. ; French, Cynthia L. ; Chang, Anne B. ; Altman, Kenneth W. ; Adams, Todd M. ; Altman, Kenneth W. ; Azoulay, Elie ; Barker, Alan F. ; Birring, Surinder S. ; Blackhall, Fiona ; Bolser, Donald C. ; Boulet, Louis Philippe ; Brightling, Christopher ; Callahan-Lyon, Priscilla ; Cowley, Terrie ; Ebihara, Satoru ; El Solh, Ali A. ; Escalante, Patricio ; Field, Stephen K. ; Fisher, Dina ; French, Cynthia T. ; Gibson, Peter ; Gold, Philip ; Harding, Susan M. ; Harnden, Anthony ; Hill, Adam T. ; Irwin, Richard S. ; Kavanagh, Joanne ; Keogh, Karina A. ; Lai, Kefang ; Lane, Andrew P. ; Lim, Kaiser ; Madison, J. Mark ; Malesker, Mark A. ; Mazzone, Stuart ; Molassoitis, Alex ; Murad, M. Hassan ; Narasimhan, Mangala ; Nguyen, Huong Q. ; Newcombe, Peter ; Oppenheimer, John ; Restrepo, Marcos I. ; Rosen, Mark ; Rubin, Bruce ; Ryu, Jay H. ; Tarlo, Susan M. ; Turmel, Julie ; Vertigan, Anne E. ; Wang, Gang ; Weinberger, Miles ; on behalf of the ; CHEST Expert Cough Panel* ; CHEST Expert Cough Panel*. / Classification of Cough as a Symptom in Adults and Management Algorithms : CHEST Guideline and Expert Panel Report. In: Chest. 2018 ; Vol. 153, No. 1. pp. 196-209.
    @article{b0c7fdf01db74276881461728019a61c,
    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 = "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 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 and Miles Weinberger and {on behalf of the} and {CHEST Expert Cough Panel*} and {CHEST Expert Cough Panel*}",
    year = "2018",
    month = "1",
    doi = "10.1016/j.chest.2017.10.016",
    language = "English",
    volume = "153",
    pages = "196--209",
    journal = "Chest",
    issn = "0012-3692",
    publisher = "American College of Chest Physicians",
    number = "1",

    }

    Irwin, RS, French, CL, Chang, AB, Altman, KW, Adams, TM, Altman, KW, Azoulay, E, Barker, AF, Birring, SS, Blackhall, F, Bolser, DC, Boulet, LP, Brightling, C, Callahan-Lyon, P, Cowley, T, Ebihara, S, El Solh, AA, Escalante, P, Field, SK, Fisher, D, French, CT, Gibson, P, Gold, P, Harding, SM, Harnden, A, Hill, AT, Irwin, RS, Kavanagh, J, Keogh, KA, Lai, K, Lane, AP, Lim, K, Madison, JM, Malesker, MA, Mazzone, S, Molassoitis, A, Murad, MH, Narasimhan, M, Nguyen, HQ, Newcombe, P, Oppenheimer, J, Restrepo, MI, Rosen, M, Rubin, B, Ryu, JH, Tarlo, SM, Turmel, J, Vertigan, AE, Wang, G, Weinberger, M, on behalf of the, CHEST Expert Cough Panel* & CHEST Expert Cough Panel* 2018, 'Classification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report', Chest, vol. 153, no. 1, pp. 196-209. https://doi.org/10.1016/j.chest.2017.10.016

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

    In: Chest, Vol. 153, No. 1, 01.2018, p. 196-209.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

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

    T2 - CHEST Guideline and Expert Panel Report

    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 - 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

    AU - Weinberger, Miles

    AU - on behalf of the

    AU - CHEST Expert Cough Panel

    AU - CHEST Expert Cough Panel

    PY - 2018/1

    Y1 - 2018/1

    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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    U2 - 10.1016/j.chest.2017.10.016

    DO - 10.1016/j.chest.2017.10.016

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    JO - Chest

    JF - Chest

    SN - 0012-3692

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