New recommendations for treatment of chronic cough

Patients suffering from a chronic cough should have that cough thoroughly investigated and X-rayed if there are any red flags for an underlying disease, according to new recommendations from Australian researchers.

The recommendations are part of an updated position statement for the diagnosis and management of the condition, published in the Medical Journal of Australia (MJA).

Cough is the most common symptom leading to medical consultation, Associate Professor Julie Marchant and her colleagues wrote in the MJA paper. A chronic cough is defined as a daily cough of greater than four weeks in children and greater than eight weeks in adults.

“Chronic cough results in significant healthcare costs, impairs quality of life and may indicate the presence of a serious underlying condition,” Associate Professor Marchant and colleagues wrote.

Marchant is a paediatric respiratory physician at the Queensland Children’s Hospital and a senior research fellow in the QUT Cough Asthma and Airways Research Group at the Australian Centre for Health Services Innovation (AusHSI).

Prevalence of chronic cough

The prevalence of chronic cough in adults has been estimated to be 9.6% globally and 8.8% in Australia, with the prevalence of chronic cough gradually increasing to a peak when people are aged in their 60s.

While, overall, chronic cough presents more commonly in middle-aged women, the condition is estimated to occur in 3% of people who have never smoked, 4% of people who used to smoke, and 8% of people who currently smoke.

In a recent study of Australian children presenting to emergency departments, 7.5% had chronic cough, and 20–23% had persistent cough at day 28.

The researchers suggested chronic cough can indicate some serious conditions — with the recommendations including separate pathways for diagnosing a child or an adult, and considering Aboriginal and Torres Strait Islander adults and children with a chronic cough to be a high-risk group.

Disproportionate burden

The prevalence of chronic wet cough in children living in Indigenous communities is around 13%. “First Nations Australians are disproportionately affected by conditions that present with chronic wet cough, such as protracted bacterial bronchitis and bronchiectasis,” Marchant and her colleagues wrote.

“The mortality difference between First Nations and non-First Nations Australians with bronchiectasis is about 22 years.”

“In 180 First Nations children aged < 5 years presenting to primary care in urban Queensland for any reason, 24% had a history of chronic cough in the previous 12 months.”

Key recommendations

The new position statement makes several recommendations for the prevention and management of chronic cough.

“Assessment of children and adults requires a focused history of the chronic cough to elicit any red flag cough pointers that may indicate an underlying disease,” Marchant and her colleagues wrote.

“Further assessment with examination should include a chest x-ray and spirometry (age, > 6 years).

“Separate paediatric and adult diagnostic management algorithms should be followed.”

“[The] management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns,” they wrote.

The authors thanked the Lung Foundation Australia and the Thoracic Society of Australia and New Zealand for their support in the preparation of the guidelines.

Image credit: iStockphoto.com/simarik