Managing Chronic Cough Due To Asthma And NAEB In Adults And Adolescents
Publication Date: January 1, 2020
Last Updated: March 14, 2022
Recommendations
1. In adult and adolescent patients with chronic cough due to asthma, we suggest that non-invasive measurement of airway inflammation has clinical utility and the presence of eosinophilic airway inflammation is likely to be associated with a more favorable response to corticosteroids (2B)
Remarks: The evidence supporting a role for non-invasive measurement of airway inflammation in asthma, especially severe asthma (ATS/ERS Guideline), in predicting a beneficial response to corticosteroids is moderate. However, cough-specific studies in asthma are limited as this symptom is not included as a specific symptom of asthma control and is generally not captured independently of other symptoms in most studies of asthma.
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2. In adult and adolescent patients with chronic cough due to asthma as a unique symptom (cough variant asthma [CVA]) we suggest that inhaled corticosteroids should be considered as first line treatment. If response is incomplete in those with CVA or if cough is the remaining isolated symptom following treatment with inhaled corticosteroids in patients with asthma in whom cough was one of their symptoms we suggest stepping-up the inhaled corticosteroid dose and considering a therapeutic trial of a leukotriene inhibitor after reconsideration of alternative causes of cough. Beta-agonists could also be considered in combination with ICS (1B)
Remarks: The evidence base supporting the step-wise treatment for asthma is very strong (as per the Global Initiative for Asthma, GINA), whereas cough-specific studies in asthma are limited as this symptom is not captured independently of other symptoms in most studies of asthma. The grade thus reflects the very strong evidence for step-wise treatment of asthma in general rather than specifically for cough.
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3. In adult and adolescent patients with chronic cough due to non-asthmatic eosinophilic bronchitis (NAEB), we suggest inhaled corticosteroids as first-choice treatment. (2B)
Remarks: There are very few therapeutic trials in NAEB and all include small numbers of subjects, making this a weak recommendation.
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4. In adult and adolescent patients with chronic cough due to NAEB, if response to ICS is incomplete, we suggest stepping-up the inhaled corticosteroid dose and considering a therapeutic trial of a leukotriene inhibitor after reconsideration of alternative causes of cough. (2C)
Remarks: There are very few therapeutic trials in NAEB and all include small numbers of subjects making this a weak recommendation.
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Title
Managing Chronic Cough Due To Asthma And NAEB In Adults And Adolescents
Authoring Organization
American College of Chest Physicians
Publication Month/Year
January 1, 2020
Last Updated Month/Year
July 5, 2023
External Publication Status
Published
Country of Publication
US
Document Objectives
Asthma and non-asthmatic eosinophilic bronchitis (NAEB) are among the commonest causes of chronic cough in adults. We sought to determine the role of non-invasive measurements of airway inflammation, including induced sputum and fractional exhaled nitric oxide, in the evaluation of cough associated with asthma, and what the best treatment is for cough due to asthma or NAEB.
Target Patient Population
Patients with chronic cough
Inclusion Criteria
Adolescent, Adult
Health Care Settings
Ambulatory, Long term care, Outpatient, School
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Diagnosis, Management, Treatment
Diseases/Conditions (MeSH)
D001249 - Asthma, D003371 - Cough, D001991 - Bronchitis, D029481 - Bronchitis, Chronic, D018927 - Anti-Asthmatic Agents
Keywords
bronchitis, cough, chronic cough, asthema
Source Citation
Côté A, Russell RJ, Boulet LP, Gibson PG, Lai K, Irwin RS, Brightling CE; CHEST Expert Cough Panel. Managing Chronic Cough Due to Asthma and NAEB in Adults and Adolescents: CHEST Guideline and Expert Panel Report. Chest. 2020 Jul;158(1):68-96. doi: 10.1016/j.chest.2019.12.021. Epub 2020 Jan 20. PMID: 31972181.
Methodology
Number of Source Documents
100
Literature Search Start Date
October 1, 2015
Literature Search End Date
December 1, 2018