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Managing Chronic Cough Due to Asthma and NAEB in Adults and Adolescents: CHEST Guideline and Expert Panel Report Managing Chronic Cough Due to Asthma and NAEB in Adults and Adolescents CHEST Guideline and Expert Panel Report AndreanneCôté,MD;RichardJ.Russell,MBBS;Louis-PhilippeBoulet,MD;PeterG.Gibson,DMed;KefangLai,MD,PhD; Richard S. Irwin, MD, Master FCCP; and Christopher E. Brightling, PhD; on behalf of the CHEST Expert Cough Panel * BACKGROUND: Asthma and non-asthmatic eosinophilic (...) bronchitis (NAEB) are among the commonest causes of chronic cough in adults. We sought to determine the role of non- invasive measurements of airway in?ammation, including induced sputum and fractional exhaled nitric oxide, in the evaluation of cough associated with asthma, and what the best treatment is for cough due to asthma or NAEB. METHODS: We undertook three systematic reviews of randomized controlled trials and observational trials of adults and adolescents> 12 years of age with a chronic cough
Managing Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report Journal Pre-proof Managing Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report Anne B. Chang, PhD, John J. Oppenheimer, MD; FCCP, Richard S. Irwin, MD, Master FCCP, on behalf of the CHEST Expert Cough Panel PII: S0012-3692(20)30325-1 DOI: https://doi.org/10.1016/j.chest.2020.01.042 Reference: CHEST 2916 To appear in: CHEST (...) Received Date: 8 November 2019 Revised Date: 11 December 2019 Accepted Date: 9 January 2020 Please cite this article as: Chang AB, Oppenheimer JJ, Irwin RS, on behalf of the CHEST Expert Cough Panel, Managing Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report, CHEST (2020), doi: https://doi.org/10.1016/j.chest.2020.01.042. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page
Acute Cough Due to Acute Bronchitis in Immunocompetent Adult Outpatients: CHEST Expert Panel Report Acute Cough Due to Acute Bronchitis in Immunocompetent Adult Outpatients CHEST Expert Panel Report Maeve P. Smith, MD; Mark Lown, PhD; Sonal Singh, MD; Belinda Ireland, MD; Adam T. Hill, MD; Jeffrey A. Linder, MD, MPH; and Richard S. Irwin, MD; on behalf of the CHEST Expert Cough Panel * BACKGROUND: Evidence for the diagnosis and management of cough due to acute bronchitis in immunocompetent (...) adult outpatients was reviewed as an update to the 2006 “Chronic Cough Due to Acute Bronchitis: American College of Chest Physicians (ACCP) Evidence- Based Clinical Practice Guidelines.” METHODS: Acute bronchitis was de?ned as an acute lower respiratory tract infection man- ifested predominantly by cough with or without sputum production, lasting no more than 3 weeks with no clinical or any recent radiographic evidence to suggest an alternative explanation. Two clinical population, intervention
Chronic Cough Due to Stable Chronic Bronchitis: CHEST Expert Panel Report Chronic Cough Due to Stable Chronic Bronchitis CHEST Expert Panel Report Q43 Mark A. Malesker, PharmD, FCCP Q1 ; Priscilla Callahan-Lyon, MD; J. Mark Madison, MD, FCCP; Belinda Ireland, MD Q2 ; and Richard S. Irwin, MD, Master FCCP; on behalf of the CHEST Expert Cough Panel * BACKGROUND: Q7 Chronic cough due to chronic bronchitis (CB) causes signi?cant Q8 impairment in quality of life, and effective treatment strategies (...) are needed. We conducted a systematic review on the management of chronic cough due to CB to update the recommendations and suggestions of the American College of Chest Physicians (CHEST) 2006 guideline on this topic. METHODS: This systematic review asked three questions: (1) What are the clinical features of the history that suggest a patient’s cough-phlegm syndrome is due to CB? (2) Can treatment of stable CB improve or eliminate chronic cough? (3) Can therapy that targets chronic cough due to CB
The Cough Trick Reduces Pain During Removal of Closed-suction Drains after Total Knee Arthroplasty: A Randomized Trial Drain removal after TKA can be painful. Prior research suggests that the "cough trick," in which a patient coughs at the same time she or he receives an injection, effectively decreases pain. To our knowledge, this intervention has not been evaluated as a way to reduce pain during other brief but painful interventions, such as removal of closed-suction drains after orthopaedic (...) surgery.Does the cough trick reduce pain while a surgeon is removing a closed-suction drain after TKA?Fifty-six patients with primary osteoarthritis who underwent primary TKA were randomized into two groups: drain removal as the patient coughed (n = 28 patients; three men, 25 women) or drain removal using the usual process, without the cough trick (n = 28 patients; three men, 25 women). The study groups were not different in terms of gender, BMI, surgical time, or other baseline variables, and other than
ERS guidelines on the diagnosis and treatment of chronic cough in adults and children 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
Activities of daily living decline is a predictor of lowered coughing ability and correlates with rehabilitative effect of tongue cleaning on coughing ability. Basic activities of daily living (ADL) is a critical indicator of independency in older adults. The purpose of this study is to evaluate impact of ADL decline on coughing ability, as determined by peak expiratory flow rate (PEFR), and to evaluate impact of ADL decline on the ability of tongue cleaning intervention to improve PEFR (...) . Methods: Participants comprised 95 residents of 11 group homes and nursing homes in Kumamoto, Japan. Participants were randomly assigned to cohorts with or without tongue cleaning intervention. Coughing ability was evaluated by measuring PEFR before and after 2 weeks, 4 weeks, and 3 months of intervention. Basic ADL was assessed by Barthel index (BI). Mean BI score among the participants was 59.3 ± 24.2. PEFR in a cohort with ≤ 60 BI score (LB) (1.2, 0.2-4.7 L s-1) was significantly lower than
Chronic Cough and Gastroesophageal Reflux in Children: CHEST Guideline and Expert Panel Report Whether gastroesophageal reflux (GER) or GER disease (GERD) causes chronic cough in children is controversial. Using the Population, Intervention, Comparison, Outcome (PICO) format, we undertook four systematic reviews. For children with chronic cough (> 4-weeks duration) and without underlying lung disease: (1) who do not have gastrointestinal GER symptoms, should empirical treatment for GERD be used (...) ? (2) with gastrointestinal GER symptoms, does treatment for GERD resolve the cough? (3) with or without gastrointestinal GER symptoms, what GER-based therapies should be used and for how long? (4) if GERD is suspected as the cause, what investigations and diagnostic criteria best determine GERD as the cause of the cough?We used the CHEST Expert Cough Panel's protocol and American College of Chest Physicians (CHEST) methodological guidelines and GRADE (Grading of Recommendations Assessment
Is there evidence backing the use of guaifensin for cough secondary to upper respiratory infection (URI)? Chiefs’ Inquiry Corner – 8/12/19 – Clinical Correlations Search Chiefs’ Inquiry Corner – 8/12/19 August 12, 2019 2 min read Clinicians frequently recommend symptomatic management for cough, specifically over-the-counter (OTC) medications, but the data doesn’t necessarily back it up. A 2014 Cochrane review of OTC medications for acute cough in adults and children found that among the 29 (...) randomized, placebo-controlled studies, there was poor reporting and little quantitative data. Among the three studies that specifically compared guaifensin and placebo, only one showed a significant difference, with patients taking guaifensin reporting a greater reduction in cough frequency and intensity after 3 days. Overall, only 11 of the 29 studies showed positive results for OTC medications such as guaifensin, dextromethorphan, and pseudophedrine. “Symptomatic management” may be an even more
Speech and language therapy for management of chronic cough. Cough both protects and clears the airway. Cough has three phases: breathing in (inspiration), closure of the glottis, and a forced expiratory effort. Chronic cough has a negative, far-reaching impact on quality of life. Few effective medical treatments for individuals with unexplained (idiopathic/refractory) chronic cough (UCC) are known. For this group, current guidelines advocate the use of gabapentin. Speech and language therapy (...) of the two studies included children. The duration of treatment and length of sessions varied between studies from four sessions delivered weekly, to four sessions over two months. Similarly, length of sessions varied slightly from one 60-minute session and three 45-minute sessions to four 30-minute sessions. The control interventions were healthy lifestyle advice in both studies.One study contributed HRQoL data, using the Leicester Cough Questionnaire (LCQ), and we judged the quality of the evidence
Are Antibiotics Effective in the Treatment of Children With Prolonged Wet Cough? Are Antibiotics Effective in the Treatment of Children With Prolonged Wet Cough? - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 73, Issue 5, Pages 453–455 Are Antibiotics Effective in the Treatment of Children With Prolonged Wet Cough? x Brit Long , MD (EBEM Commentator) , x Michael D. April , MD, DPhil (EBEM (...) Commentator) Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, TX DOI: | Publication History Published online: November 13, 2018 Expand all Collapse all Article Outline Take-Home Message Antibiotics may improve clinical cure and reduce progression of illness in children with prolonged wet cough. Methods Data Sources Authors identified trials from the Cochrane Airways Trials Register, CENTRAL, MEDLINE OvidSP, and EMBASE OvidSP through September
Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel Report Patients commonly present to primary care services with upper and lower respiratory tract infections, and guidelines to help physicians investigate and treat acute cough due to suspected pneumonia and influenza are needed.A systematic search was carried out with eight patient, intervention, comparison, outcome questions related to acute cough due to suspected pneumonia (...) or influenza.There was a lack of randomized controlled trials in the setting of outpatients presenting with acute cough due to suspected pneumonia or influenza who were not hospitalized. Both clinical suggestions and research recommendations were made on the evidence available and CHEST Expert Cough Panel advice.For outpatient adults with acute cough due to suspected pneumonia, we suggest the following clinical symptoms and signs are suggestive of pneumonia: cough; dyspnea; pleural pain; sweating, fevers
Effect of Tramadol Pretreatment on Sufentanil-Induced Cough. To investigate the effect of tramadol pretreatment on the incidence and severity of sufentanil-induced cough.Randomized controlled trial.Adults of both genders (N = 304; 18 to 65 years old, American Society of Anesthesiologists physical status I to II), scheduled for elective surgery, were randomized into two groups (n = 152): intravenous administration of tramadol 1 mg/kg (group T) or normal saline (group C). Then sufentanil bolus (...) 0.3 mcg/kg was administered intravenously in 5 seconds. The incidence and severity of cough were observed for 1 minute. Mean arterial pressure, heart rate, nausea, vomiting, and truncal rigidity during induction were also recorded.Patient characteristics were similar between the two groups. The incidence of cough was significantly lower in group T when compared with group C (7.9% vs 18.4%, P < .05); there were nine patients coughing severely in group C, whereas no severe cough occurred in group T
The impacts of cough: a cross-sectional study in a Finnish adult employee population Given the very high prevalence of cough, little is known about its impacts. A questionnaire was sent via e-mail to all public service employees in two towns in Finland. There were 373 subjects with acute cough, 174 with subacute cough and 421 with chronic cough. Cough-related quality of life was assessed with the Leicester Cough Questionnaire (LCQ) and depressive symptoms with Patient Health Questionnaire-2 (...) . In addition, data on doctor's visits and sick leave days were collected. Mean LCQ (95% CI) total scores were 16.2 (15.9-16.5), 14.5 (14.1-15.0) and 14.6 (14.3-14.9) among subjects with acute, subacute and chronic cough, respectively (p<0.001). The prevalence of depressive symptoms was 5.4%, 7.5% and 4.8%, respectively, and 5.0% among subjects without current cough (p=0.50). The respective proportions of subjects with at least one doctor's visit due to cough during the previous year were 27.6%, 44.8%, 49.6
Treatment of Interstitial Lung Disease Associated Cough: CHEST Guideline and Expert Panel Report Chronic cough in interstitial lung disease (ILD) causes significant impairment in quality of life. Effective treatment approaches are needed for cough associated with ILD.This systematic review asked: Is there evidence of clinically relevant treatment effects for therapies for cough in ILD? Studies of adults aged > 18 years with a chronic cough ≥ 8 weeks' duration were included and assessed (...) for relevance and quality. Based on the systematic review, guideline suggestions were developed and voted on by using CHEST guideline methodology.Eight randomized controlled trials and two case series (≥ 10 patients) were included that reported data on patients with idiopathic pulmonary fibrosis, sarcoidosis, and scleroderma-related ILD who received a variety of interventions. Study quality was high in all eight randomized controlled trials. Inhaled corticosteroids were not supported for cough associated
Treating Cough Due to Non-CF and CF Bronchiectasis With Nonpharmacological Airway Clearance: CHEST Expert Panel Report Treating Cough Due to Non-CF and CF Bronchiectasis With Nonpharmacological Airway Clearance CHEST Expert Panel Report Adam T. Hill, MD; Alan F. Barker, MD, FCCP; Donald C. Bolser, PhD; Paul Davenport, PhD; Belinda Ireland, MD; Anne B. Chang, MBBS, PhD, MPH; Stuart B. Mazzone, PhD; and Lorcan McGarvey, MD BACKGROUND: Inbronchiectasisduetocystic?brosis(CF)andothercauses (...) ,airwayclearanceis oneofthemainstaysofmanagement.Weconductedasystematicreviewonairwayclearanceby using non-pharmacological methods as recommended by international guidelines to develop recommendations or suggestions to update the 2006 CHEST guideline on cough. METHODS: The systematic search for evidence examined the question, “Is there evidence of clinically important treatment effects for non-pharmacological therapies in cough treatment for patients with bronchiectasis?” Populations selected were all patients
Upper airway cough syndrome Upper airway cough syndrome - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Upper airway cough syndrome Last reviewed: February 2019 Last updated: September 2018 Summary Chronic cough that occurs with coexisting upper airway symptoms, including abnormal sensations arising from the throat and a postnasal drip sensation. Sensations attributed to nasal disease may actually be manifestations (...) of a sensory neuropathic process and not relate to rate or quantity of nasal discharge. Most common cause of chronic cough in adults. No pathognomonic findings exist; diagnosis should be determined by considering a combination of criteria, including the history, physical exam, imaging, and, ultimately, the response to therapy. Trial of empirical therapy with a first-generation antihistamine plus a decongestant is both diagnostic and therapeutic. Non-pharmacological therapies also form part of the treatment