ERS guidelines on the diagnosis and treatment of chronic cough in adults and children.
- Morice AH Respiratory Research Group, Hull York Medical School, University of Hull, Hull, UK a.h.morice@hull.ac.uk.
- Millqvist E Dept of Internal Medicine/Respiratory Medicine and Allergology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
- Bieksiene K Dept of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
- Birring SS Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
- Dicpinigaitis P Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
- Domingo Ribas C Pulmonary Service, Corporació Sanitària Parc Taulí (Sabadell), Dept of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
- Hilton Boon M MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
- Kantar A Pediatric Cough and Asthma Center, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy.
- Lai K Dept of Clinical Research, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- McGarvey L Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
- Rigau D Iberoamerican Cochrane Centre, Barcelona, Spain.
- Satia I Dept of Medicine, Division of Respirology, McMaster University, Hamilton, ON, Canada.
- Smith J University of Manchester, Division of Infection, Immunity and Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK.
- Song WJ Airway Sensation and Cough Research Laboratory, Dept of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- Tonia T University of Bern, Bern, Switzerland.
- van den Berg JWK Dept of Respiratory Medicine, Hoestpoli Isala hospital, Zwolle, The Netherlands.
- van Manen MJG Dept of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Zacharasiewicz A Dept of Pediatrics, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Vienna, Austria.
- 2019-09-14
Published in:
- The European respiratory journal. - 2020
English
These guidelines incorporate the recent advances in chronic cough pathophysiology, diagnosis and treatment. The concept of cough hypersensitivity has allowed an umbrella term that explains the exquisite sensitivity of patients to external stimuli such a cold air, perfumes, smoke and bleach. Thus, adults with chronic cough now have a firm physical explanation for their symptoms based on vagal afferent hypersensitivity. Different treatable traits exist with cough variant asthma (CVA)/eosinophilic bronchitis responding to anti-inflammatory treatment and non-acid reflux being treated with promotility agents rather the anti-acid drugs. An alternative antitussive strategy is to reduce hypersensitivity by neuromodulation. Low-dose morphine is highly effective in a subset of patients with cough resistant to other treatments. Gabapentin and pregabalin are also advocated, but in clinical experience they are limited by adverse events. Perhaps the most promising future developments in pharmacotherapy are drugs which tackle neuronal hypersensitivity by blocking excitability of afferent nerves by inhibiting targets such as the ATP receptor (P2X3). Finally, cough suppression therapy when performed by competent practitioners can be highly effective. Children are not small adults and a pursuit of an underlying cause for cough is advocated. Thus, in toddlers, inhalation of a foreign body is common. Persistent bacterial bronchitis is a common and previously unrecognised cause of wet cough in children. Antibiotics (drug, dose and duration need to be determined) can be curative. A paediatric-specific algorithm should be used.
- Language
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- English
- Open access status
- bronze
- Identifiers
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- DOI 10.1183/13993003.01136-2019
- PMID 31515408
- Persistent URL
- https://susi.usi.ch/global/documents/53023
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