Publication: Chronic cough management: Practical guidelines and PICO-based evidence for screening and investigation
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Issued Date
2024-12-01
Resource Type
ISSN
0125877X
eISSN
22288694
Scopus ID
2-s2.0-85214763112
Pubmed ID
39756065
Journal Title
Asian Pacific Journal of Allergy and Immunology
Volume
42
Issue
4
Start Page
305
End Page
317
Rights Holder(s)
SCOPUS
Bibliographic Citation
Asian Pacific Journal of Allergy and Immunology Vol.42 No.4 (2024) , 305-317
Suggested Citation
Kanjanawasee D., Poachanukoon O., Sriprasart T., Chirakalwasan N., Saiphoklang N., Athipongarporn A., Senavonge A., Kamalaporn H., Sanguanwong N., Mitthamsiri W., Chiewchalermsri C., Suetrong B., Suwanchanratsamee A., Tantilipikorn P., Maneerattanaporn M., Jaruchinda P., Kawamatawong T., Luvira V., Sombuntham P., Sompornrattanaphan M., Suwanwech T., Chotchai N., Ruxrungtham K., Boonsawat W., Brannan J.D., Song W.J., Pornsuriyasak P. Chronic cough management: Practical guidelines and PICO-based evidence for screening and investigation. Asian Pacific Journal of Allergy and Immunology Vol.42 No.4 (2024) , 305-317. 317. doi:10.12932/AP-191124-1976 Retrieved from: https://hdl.handle.net/20.500.14740/20574
Author(s)
Kanjanawasee D.
Poachanukoon O.
Sriprasart T.
Chirakalwasan N.
Saiphoklang N.
Athipongarporn A.
Senavonge A.
Kamalaporn H.
Sanguanwong N.
Mitthamsiri W.
Chiewchalermsri C.
Suetrong B.
Suwanchanratsamee A.
Tantilipikorn P.
Maneerattanaporn M.
Jaruchinda P.
Kawamatawong T.
Luvira V.
Sombuntham P.
Sompornrattanaphan M.
Suwanwech T.
Chotchai N.
Ruxrungtham K.
Boonsawat W.
Brannan J.D.
Song W.J.
Pornsuriyasak P.
Poachanukoon O.
Sriprasart T.
Chirakalwasan N.
Saiphoklang N.
Athipongarporn A.
Senavonge A.
Kamalaporn H.
Sanguanwong N.
Mitthamsiri W.
Chiewchalermsri C.
Suetrong B.
Suwanchanratsamee A.
Tantilipikorn P.
Maneerattanaporn M.
Jaruchinda P.
Kawamatawong T.
Luvira V.
Sombuntham P.
Sompornrattanaphan M.
Suwanwech T.
Chotchai N.
Ruxrungtham K.
Boonsawat W.
Brannan J.D.
Song W.J.
Pornsuriyasak P.
Author's Affiliation
Ramathibodi Hospital
Siriraj Hospital
School of Medicine and Public Health
Pramongkutklao Hospital
Asan Medical Center
Faculty of Medicine, Khon Kaen University
King Chulalongkorn Memorial Hospital
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Faculty of Medicine, Thammasat University
Thammasat University
BNH Hospital
Phramongkutklao College of Medicine
Faculty of Medicine, Chulalongkorn University
Srinakharinwirot University
Saraburi Hospital
Phra Nakhon Si Ayutthaya Hospital
Siriraj Hospital
School of Medicine and Public Health
Pramongkutklao Hospital
Asan Medical Center
Faculty of Medicine, Khon Kaen University
King Chulalongkorn Memorial Hospital
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Faculty of Medicine, Thammasat University
Thammasat University
BNH Hospital
Phramongkutklao College of Medicine
Faculty of Medicine, Chulalongkorn University
Srinakharinwirot University
Saraburi Hospital
Phra Nakhon Si Ayutthaya Hospital
Corresponding Author(s)
Other Contributor(s)
Abstract
Chronic cough is a common clinical condition requiring comprehensive assessment. This review employs a symptom-focused approach, prioritizing the presenting symptom of “chronic cough” to mirror real-world clinical practice. Ten key questions regarding the investigations in the uncertain areas were systematically addressed based on the PICO framework and applying the GRADE system for evidence synthesis to provide the strength of recommendation and quality of evidence for key questions. Practical diagrams were developed to facilitate clinical decision-making. The initial evaluation involves screening for red flag signs requiring urgent attention, followed by a detailed history-taking and physical examination. A chest radiograph is recommended as the first-line investigation. The primary objective of the initial evaluation is to identify the cause and initiate appropriate treatment. If history and physical examination prove insufficient for a definitive diagnosis, referral to a specialist is advised for further specific testing. The recommendations on specific testing include fractional exhaled nitric oxide for cough variant asthma, nasal endoscopy or digital endoscopy (optional) for upper airway cough syndrome, paranasal sinus computed tomography (CT) for chronic rhinosinusitis, and laryngoscopy for hoarseness. Spirometry is for the diagnosis of obstructive airway diseases, and peak flow variability or bronchial challenge tests are complements particularly if asthma is suspected. Gastroesophageal reflux (GERD) investigations are for patients with chronic cough without typical GERD symptoms. Sinus radiographs and chest CT are not routinely recommended. Our guideline distinguishes itself by prioritizing a symptom-based clinical evaluation to guide clinicians toward the most probable diagnosis, streamlining the diagnostic process.