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Cough Guidelines

‘The Australian Cough Guidelines is a clinical guideline for the assessment of persistent cough in children and adults and was developed to assist GP’s with a treatment program based on accurate diagnosis and understanding of the causes of cough,’ said Professor Peter Gibson, Chairman of the Cough in Children and Adults: Diagnosis and Assessment (CICADA) consultative group facilitated by the Lung Foundation.

In Australia, cough is one of the most common reasons for presenting for a medical consultation with epidemiological studies identifying a 5%-10% prevalence of chronic cough in both adults and children1.

Cough is a common and distressing symptom that results in significant health care costs for adults and children from medical consultations and medication use with nonspecific cough suppressant therapy offering little benefit in managing persistent cough.

Professor Gibson said that the initial assessment for protracted or chronic cough seeks to characterize the condition based on history, to determine whether there are any alarm symptoms or findings that may indicate a serious underlying disease and to identify whether there is a specific disease present that is associated with a chronic cough.

Identification of the many different conditions that are associated with chronic cough form the basis of specific treatment and further investigation. These conditions can be identified by a probability-based diagnostic approach, by consideration of important conditions not to be missed and by reviewing cough pointers2.

Management of chronic cough involves addressing the common issues of environmental exposures and patient or parental concerns and then instituting specific therapy to manage the cough.

The most common diseases in adults are asthma, rhinitis or gastro-oesophageal reflux disease whilst in children, the most common diseases are asthma and protracted bronchitis.

CICADA’s guidelines are based on a successful problem-based clinical assessment method that is widely used in primary care3, using he principles of evidence-based medicine and the GRADE approach4 to recommendations made in guidelines to determine the strength of treatment recommendations: strong, weak, or ‘no specific recommendation’,’ said Professor Gibson.

CICADA’s Cough Guidelines Position Statement is available as a PDF file here MJA Position Statement March 2010

References:

  1. Marchant JM, Newcombe PA, Juniper EF, et al. What is the burden of chronic cough for families? Chest 2008; 134: 303-309 2006; 184: 398-403. http://www.mja.com.au/public/issues/108_08_170406/cha10981_fm.html
  2. Chang AB, Landau LI, van Asperen PP, et al. Cough in children: definitions and clinical evaluation. Position statement of the Thoracic Society of Australia and New Zealand. Med J Aust 2006; 184: 398-403. http://www.mja.com.au/public/issues/108_08_170406/cha10981_fm.html
  3. Murtagh J. Murgagh’s general practice. 4th ed. Sydney: McGraw Hill, 2007
  4. Guyatt GH, Oxman AD, Kunz R, et al. Going from evidence to recommendations. BMJ 2008; 336: 1049-1051

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