6 Guidelines for Treating Unexplained Chronic Cough

There is a great need to identify effective treatment approaches for unexplained chronic cough, as the condition can lead to significant decreases in patients’ qualify of life.

The American College of Chest Physicians has completed a systematic review of randomized controlled clinical trials to create guideline suggestions, which will be published in an upcoming issue of CHEST.

Some factors the researchers considered included cough severity, frequency, and effect on quality of life. In their review, the researchers included studies of adults and adolescents under 12 years of age with an unexplained chronic cough lasting more than 8 weeks.

The experts advised the following for patients with chronic cough:

1. Unexplained chronic cough should be defined as a cough that lasts longer than 8 weeks and remains unexplained after investigations and supervised therapeutic trials.

2. Patients with chronic cough should undergo a guideline- or protocol-based assessment, including objective tests for bronchial hyperresponsiveness and eosinophilic bronchitis, or a therapeutic corticosteroid trial.

3. Unexplained chronic cough patients should go through a therapeutic trial of multimodality speech pathology therapy.

4. In patients whose test results for bronchial hyperresponsiveness and eosinophilia (sputum eosinophils, exhaled nitric oxide) come back negative, they should not be prescribed inhaled corticosteroids.

5. Patients with unexplained chronic cough may undergo a therapeutic trial of gabapentin as long as the adverse effects and the risk-benefit profile are explained to the patient before starting the regimen. The patient and provider should also reassess the risk-benefit profile at the 6-month mark before continuing the drug, too. The researchers recommended that dosing for gabapentin should be prescribed using an escalation schedule starting at 300 mg a day with more doses added each day until a maximum tolerable dose is achieved—no more than 1800 mg a day in 2 divided doses.

6. If the patients have a negative workup for acid gastroesophageal reflux disease, proton pump inhibitor therapy should not be prescribed.

These guidelines have so far been endorsed by the American Academy of Otolaryngology Head and Neck Surgery, American Association for Respiratory Care, American Thoracic Society, Irish Thoracic Society, and Lung Foundation Australia.

“This guideline chapter, another from CHEST living guidelines, provides the most up-to-date treatment options for patients living with unexplained chronic cough,” Richard S. Irwin, MD, master FCCP, and chairman of the Diagnosis and Management of Cough: CHEST Evidence Based Clinical Practice Guidelines, concluded in a press release. “The guideline presents suggestions for diagnosis and treatment based on the best available evidence and identifies gaps in our knowledge and areas for future research.”