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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Recommendation Grading

Overview

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

December 16, 2024

Supplemental Implementation Tools

Document Type

Guideline

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.

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
100
Literature Search Start Date
October 1, 2015
Literature Search End Date
December 1, 2018