Assessment and management of chronic cough

Our review highlights the need for further studies in patient populations with unexplained or refractory chronic cough as determined by current diagnostic and empiric treatment recommendations. Further, it shows the need for more systematic design and reporting of these studies and assessment of the...

Full description

Bibliographic Details
Main Author: McCrory, Douglas C.
Corporate Authors: United States Agency for Healthcare Research and Quality, Duke University Evidence-based Practice Center, Effective Health Care Program (U.S.)
Format: eBook
Language:English
Published: Rockville, Md. Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services [2013], 2013
Series:Comparative effectiveness review
Subjects:
Online Access:
Collection: National Center for Biotechnology Information - Collection details see MPG.ReNa
LEADER 06228nam a2200373 u 4500
001 EB000943576
003 EBX01000000000000000737166
005 00000000000000.0
007 tu|||||||||||||||||||||
008 150223 r ||| eng
100 1 |a McCrory, Douglas C. 
245 0 0 |a Assessment and management of chronic cough  |h Elektronische Ressource  |c prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Duke Evidence-based Practice Center ; investigators, Douglas C. McCrory ... [et al.] 
260 |a Rockville, Md.  |b Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services  |c [2013], 2013 
300 |a 1 PDF file (1 v. (various pagings)  |b ill.) 
505 0 |a Includes bibliographical references 
653 |a United States 
653 |a Cough / diagnosis 
653 |a Cough / therapy 
653 |a Chronic Disease 
710 2 |a United States  |b Agency for Healthcare Research and Quality 
710 2 |a Duke University Evidence-based Practice Center 
710 2 |a Effective Health Care Program (U.S.) 
041 0 7 |a eng  |2 ISO 639-2 
989 |b NCBI  |a National Center for Biotechnology Information 
490 0 |a Comparative effectiveness review 
500 |a Contract No. 290-2007-10066-I.. - "January 2013." 
856 4 0 |u https://www.ncbi.nlm.nih.gov/books/NBK116707  |3 Volltext  |n NLM Bookshelf Books  |3 Volltext 
082 0 |a 610 
520 |a Our review highlights the need for further studies in patient populations with unexplained or refractory chronic cough as determined by current diagnostic and empiric treatment recommendations. Further, it shows the need for more systematic design and reporting of these studies and assessment of their patient-centered outcomes. This is in contrast to the more extensive literature on the management of acute cough 
520 |a Classes of drugs evaluated included opioid, anesthetic, and nonopioid/nonanesthetic antitussives; expectorant and mucolytic protussives; antihistamines; antibiotics; inhaled corticosteroids; and inhaled anticholinergics. The opioid and certain nonopioid/nonanesthetic antitussives most frequently demonstrated efficacy for managing chronic cough in adults. In particular, codeine and dextromethorphan reduced cough severity and frequency. Relative to placebo, the effect of dextromethorphan on cough severity was 0.54 (95% confidence interval [CI], 0.27 to 0.80; p=0.0008), and the effect of opiates was 0.63 (95% CI, 0.40 to 0.86; p<0.0001). Relative to placebo, the effect of dextromethorphan on cough frequency was 0.40 (95% CI, 0.18 to 0.85; p=0.0248), and the effect of codeine was 0.57 (95% CI, 0.36 to 0.91; p=0.0260).  
520 |a However, due to inconsistency and imprecision of results, and small numbers of direct comparisons, the overall SOE is insufficient to draw firm conclusions about the comparative effectiveness of these agents. Very few studies evaluated nonpharmacological therapies (two studies) or the management of cough in children (three studies). CONCLUSIONS: Several instruments for assessing cough severity, frequency, and impact on cough-specific quality of life show good internal consistency but variable correlation with other cough measurement tools, meaning that a number of instruments are precise but their accuracy is less clear. Although the evidence is sparse, the opioid and certain nonopioid/nonanesthetic antitussives most frequently demonstrated efficacy for managing the symptom of chronic cough in adults.  
520 |a The Leicester Cough Questionnaire (LCQ) and Cough-specific Quality of Life Questionnaire (CQLQ) were the most widely studied instruments in adults; there is moderate strength of evidence (SOE) to support both the LCQ's and the CQLQ's validity in assessing severity/QOL of cough. For pediatric populations, there is moderate SOE to support the Parent Cough-specific Quality of Life questionnaire's (PC-QOL) validity in assessing severity/QOL of cough. Electronic recording devices are accurate for assessing cough frequency, but show variable correlation with other tools. Although visual analog scales (VAS) are easy to administer and have face validity, we did not identify any studies to formally validate their accuracy in assessing cough. We identified no studies exploring the impact of cough assessment instruments on therapeutic efficacy or patient outcome efficacy. Forty-eight studies (2,923 patients) evaluated 67 therapeutic comparisons for patients with chronic cough.  
520 |a REVIEW METHODS: Two investigators screened each abstract and full-text article for inclusion, abstracted data, rated quality and applicability, and graded evidence. Random-effects models were used to compute summary estimates of effects. We supplemented the meta-analysis of direct comparisons with a mixed treatment meta-analysis that incorporated data from placebo comparisons and head-to-head comparisons. RESULTS: To evaluate instruments for assessing cough, we considered the dimensions of cough frequency, cough severity, and cough-specific quality of life (QOL). We sought to measure the validity, reliability, and responsiveness of various instruments used to assess each of these dimensions. Seventy-eight studies (5,927 subjects) evaluated instruments for assessing cough.  
520 |a OBJECTIVES: Cough is the most common complaint for patients seeking medical attention in the United States. Although the most common cause of cough is acute self-limited viral infections, chronic cough (cough that lasts more than 4 weeks in children <14 years of age or more than 8 weeks in adolescents and adults) has a significant impact on quality of life and is responsible for up to 38 percent of pulmonary outpatient visits. Furthermore, a treatable cause is absent in up to 46 percent of patients with chronic cough despite a thorough diagnostic investigation. The comparative value of tools for assessing cough and the comparative effectiveness of treatments for unexplained or refractory cough are uncertain. DATA SOURCES: We searched PubMed(r), Embase(r), and the Cochrane Database of Systematic Reviews (June 4, 2012) for relevant English-language comparative studies.