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Assessment and Management of Chronic Cough [Internet]

Assessment and Management of Chronic Cough [Internet]

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US)

Version: January 2013

Results

In what follows, we begin by describing the results of our literature searches. We then provide a brief description of the included studies. The remainder of the chapter is organized by Key Question (KQ). Under each of the two KQs, we begin by listing the key points of the findings, followed by a brief description of included studies, followed by a more detailed synthesis of the evidence. The detailed syntheses under are organized by measures of cough frequency, cough severity, and responsiveness. The detailed syntheses under are organized by comparison drug classes (antitussives, protussives, other agents). We conducted quantitative syntheses where possible, as described in the Methods chapter.

Introduction

In the United States, cough is the most common complaint for which patients seek medical attention and is the second most common reason for a general medical examination, accounting for over 26 million office visits annually. Cough often results from an acute, self-limited, viral upper respiratory tract infection; however, there are multiple causes of cough beyond this, including both respiratory tract and nonrespiratory tract-related etiologies. Cough that lasts more than 4 weeks in children younger than 14 years of age or more than 8 weeks in adolescents and adults 14 years of age and older is considered to be chronic by the American College of Chest Physicians (ACCP)., Such chronic cough is responsible for up to 38 percent of pulmonary outpatient visits., The purpose of this review is to evaluate the effectiveness of instruments to evaluate cough and the comparative effectiveness of treatments for the symptom of cough in patients with either unexplained or refractory chronic cough. Recent studies from the UK, United States, and Japan evaluating patients with chronic cough have estimated that up to 46 percent of patients have idiopathic cough despite a thorough diagnostic investigation.

Discussion

In this comparative effectiveness review (CER), we reviewed 78 studies involving 5927 patients that evaluated instruments used to assess cough (Key Question [KQ] 1) and 48 studies involving 2923 patients that evaluate nonspecific (or symptomatic) therapies to treat patients with chronic cough (KQ 2). We hoped to evaluate the comparative effectiveness of these instruments and treatments both in adults and in children (< 14 years of age). The evidence—especially related to the effectiveness of nonpharmacological therapies and to children—was very limited.

Executive Summary

In the United States, cough is the most common complaint for which patients seek medical attention and is the second most common reason for a general medical examination, accounting for more than 26 million office visits annually. Cough often results from an acute, self-limited, viral upper respiratory tract infection; however, there are multiple causes of cough beyond this, including both respiratory tract and nonrespiratory tract-related etiologies. Cough that lasts more than 4 weeks in children younger than 14 years of age or more than 8 weeks in adolescents and adults 14 years of age and older is considered to be chronic by the American College of Chest Physicians (ACCP)., Cough serves a potentially beneficial purpose by clearing the airways of excessive mucus, irritants, or abnormal substances such as edema fluid or pus. But while cough may serve a useful function, it can also lead to a variety of problems, including exhaustion (57%), feeling self-conscious (55%), insomnia (45%), changes in lifestyle (45%), musculoskeletal pain (45%), hoarseness (43%), excessive perspiration (42%), and urinary incontinence (39%). These problems are more likely to be prominent in the setting of chronic versus acute cough. As a consequence, chronic cough is responsible for up to 38 percent of pulmonary outpatient visits.,

Methods

The methods for this comparative effectiveness review (CER) follow those suggested in the Agency for Healthcare Research and Quality (AHRQ) Methods Guide for Effectiveness and Comparative Effectiveness Reviews (hereafter referred to as the Methods Guide) and Methods Guide for Medical Test Reviews (hereafter referred to as the Medical Test Guide). The main sections in this chapter reflect the elements of the protocol established for the CER; certain methods map to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. All methods and analyses were determined a priori.

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