ERS guidelines on the diagnosis and treatment of chronic cough in adults and children

Abstract

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.

Managing the supportive care needs of those affected by COVID-19

“…However, because of the likely concurrent need for breathlessness management, strong opioids are likely to be more pragmatic in practice. High-level evidence is limited [21,22], but relatively low doses of long-acting oral morphine (5-10 mg twice daily) are helpful in refractory chronic cough (table 1) [21]. Although these patients do not have chronic cough, opioids may be helpful in reducing cough alongside treatment for breathlessness [22].…”

Cluster analysis in 975 patients with current cough identifies a phenotype with several cough triggers, many background disorders, and low quality of life

“…On the contrary, 88.0 % of the patients of the cluster B had one or more cough background disorders. This is not an unexpected nding because all these disorders are well known to associate with chronic cough (3,7). It is well known that chronic obstructive pulmonary disease (COPD) also causes chronic cough.…”

Coughing in Small Animal Patients

“…Cough is an important protective reflex to enhance airway clearance and prevent aspiration (5). The ERS defines chronic cough as lasting at least 8 weeks in adults and 4 weeks in children (7). A cough is considered chronic in veterinary patients if it has been present for at least 2 months (8).…”