Diagnoses and management of adult cough: An Indian Environmental Medical Association (EMA) position paper

Diagnoses and management of adult cough: An Indian Environmental Medical Association (EMA) position paper

Cough is a common yet distressing symptom that results in significant health care costs from outpatient visits and related consultations. The understanding of the pathobiology of cough in recent times has undergone an evolution with Cough hypersensitivity syndrome (CHS) being suggested in most cases...

Full description

Saved in:
Bibliographic Details
Published in:Respiratory medicine Vol. 168; p. 105949
Main Authors: Shankar, P.S., Korukonda, K., Bendre, S., Behera, D., Mirchandani, L., Awad, N.T., Prasad, R., Bhargava, S., Sharma, O.P., Jindal, S.K.
Format: Journal Article
Language:English
Published: England Elsevier Ltd 01-07-2020
Elsevier Limited
Subjects:
Algorithms
Allergic bronchopulmonary aspergillosis
Antitussive agents
Aspergillosis
Asthma
Bronchiectasis
Bronchodilator agents
Bronchodilators
Chlamydia
Chronic obstructive pulmonary disease
Cough
Empirical analysis
Environmental management
Etiology
Expectorants
Health care
Histamine
Hypersensitivity
Inflammation
Medical diagnosis
Mucociliary clearance
Pathogens
Patients
Pneumonia
Smoking
Streptococcus infections
Tuberculosis
Antitussive agents
Expectorants
Mucociliary clearance
Cough
Bronchodilator agents
Asthma
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Cough is a common yet distressing symptom that results in significant health care costs from outpatient visits and related consultations. The understanding of the pathobiology of cough in recent times has undergone an evolution with Cough hypersensitivity syndrome (CHS) being suggested in most cases of dry cough. However, in the case of productive cough, ancillary mechanisms including impaired Mucociliary clearance, in addition to hypermucosecretory bronchospastic conditions of Smoker's cough, asthma-COPD overlap, bronchiectasis, and allergic bronchopulmonary aspergillosis, need to be critically addressed while optimizing patient care with symptomatic therapy in outpatient settings of India. In this review, evidence-based graded recommendations on use of antitussives - & protussives as a Position Paper were developed based on the Level and Quality of Scientific evidence as per Agency for Health Care and Quality (AHRQ) criteria listing and Expert opinions offered by a multidisciplinary EMA panel in India. Management of acute or chronic cough involves addressing common issues of environmental exposures and patient concerns before instituting supportive therapy with antitussives or bronchodilatory cough formulations containing mucoactives, anti-inflammatory, or short-acting beta-2 agonist agents. The analyses provides a real world approach to the management of acute or chronic cough in various clinical conditions with pro- or antitussive agents while avoiding their misuse in empirical settings. •Real world approach on diagnosis and management of chronic cough with anti- or protussive formulations.•Pragmatic algorithmic approach for assessment of acute and chronic cough phenotypes.•Mucociliary clearance is impacted in Bronchiectasis, cystic fibrosis, chronic bronchitis, asthma or ACO and ABPA.•Chronic dry cough involving Cough hypersensitivity syndrome is often amenable to treatment with antitussive with complimentary actions.•Bronchodilators offer mechanistic reasoning for improvement of mucociliary clearance for evaluation in productive cough management.
ISSN:0954-6111
1532-3064
DOI:10.1016/j.rmed.2020.105949