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.

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Effect direction (evidence to indicate improvement, deterioration, or no change in an outcome) can be used as a standardized metric which enables the synthesis of diverse effect measures in systematic reviews. The effect direction (ED) plot was developed to support the synthesis and visualization of effect direction data. Methods for the ED plot require updating in light of new Cochrane guidance on alternative synthesis methods. To update the ED plot, statistical significance was removed from the algorithm for within-study synthesis and use of a sign test was considered to examine whether patterns of ED across studies could be due to chance alone. The revised methods were applied to an existing Cochrane review of the health impacts of housing improvements. The revised ED plot provides a method of data visualization in synthesis without meta-analysis that incorporates information about study characteristics and study quality, using ED as a common metric, without relying on statistical significance to combine outcomes of single studies. The results of sign tests, when appropriate, suggest caution in over-interpreting apparent patterns in effect direction, especially when the number of included studies is small. The revised ED plot meets the need for alternative methods of synthesis and data visualization when meta-analysis is not possible, enabling a transparent link between the data and conclusions of a systematic review. ED plots may be particularly useful in reviews that incorporate nonrandomized studies, complex systems approaches, and diverse sources of evidence, due to the variety of study designs and outcomes in such reviews.