Classification of Cough as a Symptom in Adults and Management Algorithms

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

doi:10.1016/j.chest.2017.10.016

Cited by 345 publications

(313 citation statements)

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“…The order in and degree to which underlying potential causes for cough should be pursued remains unclear . Published guidelines from the American College of Chest Physicians on the diagnosis and treatment of chronic cough recommend an integrative approach considering “upper airway cough syndrome” (UACS), asthma, and GERD . These guidelines, however, do not define a clear pathway for diagnosing alternate and multifactorial sources of cough in CRS patients .…”

Section: Discussionmentioning

confidence: 99%

“…Published guidelines from the American College of Chest Physicians on the diagnosis and treatment of chronic cough recommend an integrative approach considering “upper airway cough syndrome” (UACS), asthma, and GERD . These guidelines, however, do not define a clear pathway for diagnosing alternate and multifactorial sources of cough in CRS patients . Given that asthma is frequently prevalent in CRS patients and has prognostic and management implications, understanding the relationship of cough with asthma in CRS patients may offer insight on the diagnosis of this symptom.…”

Section: Discussionmentioning

confidence: 99%

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Association of cough with asthma in chronic rhinosinusitis patients

Marino

Lal

2020

Laryngoscope Investig Oto

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Objective: To determine whether the complaint of cough in chronic rhinosinusitis (CRS) patients is associated with asthma and if there is a potential predictive value for asthma diagnosis.Method: Consecutive patients presenting for initial evaluation at a tertiary rhinology clinic who were diagnosed with CRS were considered for inclusion in a crosssectional study. The presence and severity of cough was determined using the 22-item Sinonasal Outcome Test (SNOT-22). Subgroup analysis included asthma diagnosis confirmed by pulmonary function testing (PFT) in our institution, and for chronic rhinosinusitis patients with (CRSwNP) and without nasal polyps (CRSsNP).Results: The total study population included 297 patients with a diagnosis of CRS, with 63.9% of patients reporting cough. Physician-confirmed diagnosis of asthma was made in 38.7% of patients, and confirmed in 69.6% by PFT. Cough was more frequently reported by CRS patients diagnosed with asthma (relative risk [RR] = 1.60, 95% confidence interval [CI], 1.13-2.25), with sensitivity of 73.9% (95% CI, 65.0%-81.1%). This remained significant in the CRSsNP subgroup (RR = 2.65, 95% CI, 1.32-5.30), with sensitivity of 83.3% (95% CI, 70.4%-91.3%) and specificity of 41.2% (95% CI, 33.2%-49.8%). Cough was not associated with asthma in CRSwNP patients (RR = 1.26, 95% CI, 0.89-1.79). Cough severity had poor predication for asthma diagnosis (AUC = 0.60, 95% CI, 0.54-0.65).Conclusions: Complaint of cough is associated with diagnosis of asthma in CRS patients. In CRSsNP, complaint of cough was sensitive for asthma diagnosis, although specificity was low. Cough in CRS patients can be multifactorial and asthma may be an important diagnostic consideration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of cough with asthma in chronic rhinosinusitis patients

Marino

Lal

2020

Laryngoscope Investig Oto

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“…제를 중단해보거나, 폐기능 검사상 기도폐색 소견이 있는 환 자에서 기관지 확장제 반응 검사를 시행하는 것이다.Sitagliptin은 ACCP 진료 지침에서 기침 유발 약제로 고려되 도록 기술되어 있으나[3], 초기 임상시험을 제외한 나머지 모든 결과에서 위약 대비 기침 위험이 증가하지 않은 점에서 기침 환자에서 중단을 고려해야 하는 약물이 아닐 가능성이 높다[43].당히 낮다는 것이다. 따라서 2019 ERS 진료 지침에서는 진찰 소견과 흉부 X선 검사가 정상인 환자에서는 흉부 CT 검사를 시행하지 않도록 제안하였다[22].…”

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New Approach to Chronic Cough: An Introductory Guide Based on Recent Clinical Practice Guidelines

송우정¹,

김상훈²

2019

Korean J Med

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The cough reflex is a vital protective mechanism for the lower airways against aspiration, but when dysregulated, it becomes a clinical problem. Indeed, chronic cough is an important clinical issue as it is common in the general population and causes considerable morbidity. Anatomic diagnostic protocols were the first breakthrough in the management of patients with chronic cough; however, as systematic approaches are not always successful, a new paradigm of cough hypersensitivity syndrome has been proposed. The introduction of this paradigm has provided new opportunities for managing chronic cough, including development of new cough assessment tools and effective cough control therapies. However, it also warranted re-appraisal of existing clinical evidence and refinement of our clinical pathways. Against this background, international and domestic evidence-based practice guidelines based on a strict methodology have been published recently. In this review, we introduce clinical approaches based on the concept of cough hypersensitivity syndrome and discuss key aspects of recently published guidelines for chronic cough in adults. (Korean J Med 2019;94:471-484) -472 -서 론 기침은 해로운 물질의 흡인(aspiration)으로부터 기관지와 폐를 보호하기 위한 반사 기전이지만, 조절되지 않는 기침은 환자가 병원을 찾는 가장 흔한 문제이기도 하다[1]. 기침 반 사는 흔히 호흡기 바이러스 감염에 의해 과민해지나 대부분 2-3주 이내 자연 호전된다[2]. 하지만 일부 환자에서는 기침 이 정상화되지 않고 오래 지속되는데, 성인에서 8주 이상 지 속될 경우(소아에서는 4주), 자연 호전 가능성이 낮고, 별도 의 진단과 치료가 필요한 경우가 많다. 따라서 전문가 집단 에서는 이러한 기침을 '만성 기침'으로 구분하여 다루고 있 다[3-5]. 만성 기침은 삶의 질을 심각하게 저해하는 의학적 문제로, 다양한 신체적, 정신적, 사회적 합병증을 야기한다[6-8]. 그 중에서도 특히 사회적 합병증이 중요한데, 기침이 감염병의 증상이기도 하여 대인관계의 고립과 사회생활의 문제를 야 기할 수 있기 때문이다[9,10]. 지역사회 성인에서 만성 기침 유병률은 세계적으로는 약 10% [11], 한국인에서는 2-5% 정 도로 흔한 문제이다[12]. 노인에서 유병률이 높은 특징이 있 으므로, 최근 빠른 인구 고령화 추세를 고려할 때 만성 기침 의 질병 부담은 지속적으로 증가할 것으로 예상된다[13]. 만성 기침에 대한 국제 진료 지침은 1990년대 이후 미국흉 부의사학회(American College of Chest Physician, ACCP)와 유 럽호흡기학회(European Respiratory Society, ERS) 등 전문가 집단을 중심으로 개발되기 시작하였다[4,14,15]. 이들 진료지 침은 미주신경 기침 반사 회로의 해부학적 분포에 기반하여, 기침의 원인 질환-특히, 천식, 상기도 및 하기도 염증, 위식 도 역류 질환(gastroesophageal reflux, GERD) 등을 체계적으 로 진단하고 치료하는 것을 원칙으로 하고, 이러한 접근법을 "해부학적 진단 프로토콜"이라 부른다[16]. 이러한 체계적 접근법의 성과는 우수한 편으로, 초기 연구에서는 95% 이상 의 환자에서 기침이 해결되는 것으로 보고되었으나[17], 2000년대 중반 이후 누적된 임상 경험과 연구 결과를 통해 해부학적 진단 프로토콜이 완벽하지 않음을 알게 되었다. 특

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“…As part of their work in updating the CHEST Organization's 2006 cough guidelines, the CHEST Expert Cough Panel has spoken about the importance of routinely measuring cough outcomes with valid and reliable tools in clinical research studies and in the clinic . Based on a systematic review of literature that focused on intervention fidelity to cough guidelines, the panel came to understand that authors infrequently did what they said they did or did not document what they said they did.…”

mentioning

confidence: 99%

“…In summary, we agree with Koo et al that a simple, easy‐to‐use cough severity tool should be required for use in everyday clinical practice. Guidelines for when to use such a tool have been published …”

mentioning

confidence: 99%