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

Published on Jan 1, 2020in European Respiratory Journal11.807
路 DOI :10.1183/13993003.01136-2019
Alyn H. Morice30
Estimated H-index: 30
(Hull York Medical School),
Eva Millqvist28
Estimated H-index: 28
(Sahlgrenska University Hospital)
+ 15 AuthorsAngela Zacharasiewicz9
Estimated H-index: 9
(University of Vienna)
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/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, (which, dose, and duration need to be determined) can be curative. Paediatric specific algorithm should be used.
  • References (140)
  • Citations (10)
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References140
Newest
#1Lorcan McGarvey ('QUB': Queen's University Belfast)H-Index: 38
#2Peter G. Gibson (University of Newcastle)H-Index: 83
Terminology used to define clinical cough is based on features such as duration, underlying causes, and associated characteristics such as whether the cough is 鈥渄ry鈥 or 鈥減roductive.鈥 Terms such as 鈥渞efractory chronic cough,鈥 鈥渦nexplained chronic cough,鈥 and 鈥渋diopathic cough鈥 are commonly used to describe a cough that persists despite extensive investigation and therapeutic trials. The use of these terms, sometimes interchangeably, has led to a degree of confusion and with the emergence of the n...
1 CitationsSource
#1Alyn H. Morice (Hull York Medical School)H-Index: 30
#2Michael Kitt (MSD: Merck & Co.)H-Index: 4
Last. Caroline Wright (Hull York Medical School)H-Index: 7
view all 9 authors...
We evaluated the effect of gefapixant on cough reflex sensitivity to evoked tussive challenge. In this phase 2, double-blind, two-period study, patients with chronic cough (CC) and healthy volunteers (HV) were randomised to single-dose gefapixant 100鈥卪g or placebo in a crossover fashion. Sequential inhalational challenges with ATP, citric acid, capsaicin and distilled water were performed 1,聽3聽and 5鈥卙 after dosing. Mean concentrations evoking 鈮2 coughs (C2) and 鈮5 coughs (C5) post dose versus ba...
4 CitationsSource
#1Stuart B. Mazzone (University of Melbourne)H-Index: 33
#2Michael J. Farrell (Monash University, Clayton campus)H-Index: 37
Abstract Cough is an important protective mechanism for clearing the airways but becomes a troublesome, and often difficult to treat, symptom in respiratory disease. Although cough can be produced as a reflex in response to the presence of irritants within the airways, emerging research demonstrates an unappreciated complexity in the peripheral and central neural systems that regulate cough. This complexity includes multiple primary sensory neurons that can induce or facilitate reflex coughing, ...
2 CitationsSource
#1Peter Hajek (QMUL: Queen Mary University of London)H-Index: 44
#2Anna Phillips-Waller (QMUL: Queen Mary University of London)H-Index: 2
Last. Hayden McRobbie (QMUL: Queen Mary University of London)H-Index: 35
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漏 2019 Massachusetts Medical Society. BACKGROUND E-cigarettes are commonly used in attempts to stop smoking, but evidence is limited regarding their effectiveness as compared with that of nicotine products approved as smoking-cessation treatments. METHODS We randomly assigned adults attending U.K. National Health Service stop-smoking services to either nicotine-replacement products of their choice, including product combinations, provided for up to 3 months, or an e-cigarette starter pack (a sec...
112 CitationsSource
#1Anne E. Vertigan (University of Newcastle)H-Index: 10
#2Sarah M. Kapela ('JHCH': John Hunter Hospital)H-Index: 2
Last. Peter G. Gibson (University of Newcastle)H-Index: 83
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Background Chronic refractory cough (CRC), a phenotype of cough hypersensitivity syndrome (CHS), is a disabling problem. Laryngeal dysfunction may be important in CRC and CHS because laryngeal symptoms are common; however, the role of laryngeal dysfunction in CHS has not been systematically examined. Objective To determine the nature of laryngeal dysfunction in patients with CRC and compare with the related laryngeal conditions of vocal cord dysfunction (VCD) and muscle tension dysphonia (MTD). ...
6 CitationsSource
4 CitationsSource
#1Stuart B. Mazzone (University of Melbourne)H-Index: 33
#2Kian Fan Chung (NIH: National Institutes of Health)H-Index: 108
Last. Lorcan McGarvey ('QUB': Queen's University Belfast)H-Index: 38
view all 3 authors...
Summary Cough is a troublesome and difficult-to-treat symptom that accompanies a diverse range of pulmonary and extrapulmonary conditions. Although considerable advances have been made over recent years in basic cough biology, this has not translated into improved clinical management. A major challenge has been in understanding the heterogeneity underlying the development and persistence of chronic cough in different patients. We present evidence that such heterogeneity begins with the multiple ...
13 CitationsSource
#1Anne M. L盲ttiH-Index: 2
#2Juha PekkanenH-Index: 87
Last. Heikki O. KoskelaH-Index: 19
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#1Jennifer M. Burke (Hull and East Yorkshire Hospitals NHS Trust)H-Index: 1
#2Warren Jackson (Hull and East Yorkshire Hospitals NHS Trust)H-Index: 1
Last. Alyn H. Morice (Hull York Medical School)H-Index: 30
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Abstract Purpose Cough Hypersensitivity Syndrome is the urge to cough following minimal stimulation, but its mechanism and method of provocation remain unexplained. 121 patients (44 males, 77 females; age range 18鈥81 years) were evaluated. Procedures High resolution manometry was performed on consecutive patients presenting with unexplained respiratory symptoms (Respiratory Group 61). Data were compared with matched controls, i.e. dyspepsia without respiratory symptoms (Dyspepsia Group 60). Main...
4 CitationsSource
#1Marc Miravitlles (Ciber)H-Index: 62
#2Thomy Tonia (University of Bern)H-Index: 18
Last. Guy Brusselle (EUR: Erasmus University Rotterdam)H-Index: 62
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Clinical practice guidelines have to respond to the needs of users http://ow.ly/Vui330iwPbY
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Abstract Cough in asthma predicts disease severity, prognosis, and is a common and troublesome symptom. Cough is the archetypal airway neuronal reflex, yet little is understood about the underlying neuronal mechanisms. It is generally assumed that symptoms arise because of airway hyper-responsiveness and/or airway inflammation, but despite using inhaled corticosteroids and bronchodilators targeting these pathologies, a large proportion of patients have persistent coughing. This review focuses on...
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#1Woo-Jung Song (UOU: University of Ulsan)H-Index: 20
#2Kian Fan Chung (NIH: National Institutes of Health)H-Index: 108
ABSTRACTIntroduction: Knowledge of the pathophysiology of cough has continued to advance over recent decades. Establishing anatomic-diagnostic protocols, based on the anatomy and distribution of va...
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#1James H. HullH-Index: 16
#2Emil Schwarz Walsted (Bispebjerg Hospital)H-Index: 7
Last. J SelbyH-Index: 2
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Chronic cough (CC) is a debilitating symptom affecting approximately one in ten of the general population and leading to impaired quality of life and social exclusion [1]. Many individuals with CC localise their symptoms to the throat area and report sensations such as a 鈥減ersistent tickling鈥, 鈥渋rritation鈥 or 鈥渂lockage鈥 in the throat [2]. They also often describe that symptoms are provoked by non-specific environmental triggers, such as exposure to scents or odours. In many patients, there is al...
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#1Ji Yu Zou (LNUTCM: Liaoning University of Traditional Chinese Medicine)
#2Li Jian Pang (LNUTCM: Liaoning University of Traditional Chinese Medicine)
Last. Xiao Dong Lv (LNUTCM: Liaoning University of Traditional Chinese Medicine)
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Abstract Introduction Zhisousan is a classical prescription consisting of seven Chinese herbal medicines and has been used historically in the treatment of chronic cough. The chemical constituents and targets of Zhisousan were identified using a network pharmacological analysis. Methods Parameters such as the oral utilization rate and the drug similarity of ingredients in Zhisousan were obtained, effective ingredients of traditional Chinese medicine were screened, and targets of effective ingred...
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#1Fang Yi (Guangzhou Medical University)H-Index: 2
#2Lina Han (Guangzhou Medical University)H-Index: 2
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Abstract Background Not all patients with cough variant asthma (CVA) show responsiveness to bronchodilators (RB) in clinic. Whether there are specific clinical and pathophysiological features can indicate RB in patients with CVA needs further investigation. Thus, we aimed to investigate the RB in patients with CVA and associated factors. Methods Forty-two CVA patients were randomized in a 2:1 ratio to receive oral bambuterol hydrochloride (10鈥痬g, once daily, for 3 days) or matched placebo, 36 pa...
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#1Kefang Lai (Guangzhou Medical University)H-Index: 11
#2Li Long (Guangzhou Medical University)
Chronic cough is one of the most common complaints for which patients in China seek medical attention. However, there are no nationwide data on the prevalence and socioeconomic burden of chronic cough. Although approximately 50% of Chinese men smoke, the vast majority of patients presenting for evaluation of chronic cough are never smokers. An equal sex distribution and a middle-aged predominance have been observed in the Chinese chronic cough population, despite demonstration of a higher cough ...
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Coughing is one of the most common complaints in human medicine. In veterinary medicine, coughing is an equally large problem and one that plays a significant role in the owner鈥檚 perception of their pet鈥檚 quality of life. In human and veterinary medicine, therapy for chronic cough is often ineffective. The complexity of the cough pathway and variances between species have made it difficult to develop an effective antitussive agent. Of the few effective antitussive agents currently available, the...
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#1Ghassan Hamad (Hull York Medical School)
#2Alan S. Rigby (Hull York Medical School)H-Index: 42
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#1Lorna Latimer (University of Leicester)H-Index: 2
#2Marieke L. Duiverman (UMCG: University Medical Center Groningen)H-Index: 9
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