Cough Management

Guideline Rank: 3†
Date of Annual Review: 2007

Abstract
The impact of cough on health is substantial. It can (1) be an important defense mechanism that helps clear excessive secretions and foreign material from the airways; (2) be an important factor in the spread of infection; and (3) present as one of the most common symptoms for which patients seek medical attention and spend health-care dollars.¹

Cough of undifferentiated duration is one of the most common complaints for which patients seek medical attention. In fact, it is the most common complaint leading patients to consult with primary care physicians in the United States and Australia.²³ Of the estimated 829.3 million visits to office-based physicians in the United States in 1998, 3.6%, or 29.5 million visits, were for cough.² Because the common cold is the most common affliction of man and woman, and it is almost always accompanied by an acute⁴ (ie, < 3 weeks in duration)⁵ and usually self-limited cough, it is likely that the greatest majority of these coughs being seen by primary care physicians are acute in duration. Additionally, referral of a patient with a persistently troublesome chronic cough (ie, > 8 weeks in duration)⁵ of unknown etiology has been shown to be one of the most common reasons for new patient visits to pulmonologists or respirologists.¹

While the annual aggregate cost of treating cough on a global basis is not known, it can be conservatively estimated to exceed several billion dollars.⁶ This estimate is primarily derived from data from the over-the-counter market for cough and cold products collected in 1999. It has been estimated that in the United Kingdom and United States hundreds of millions of pounds and several billion dollars, respectively, are spent for these products that for the most part are at best only partially effective.6 These figures clearly underestimate the total cost of treating cough because they do not include the cost of prescription drugs for the common cold and other causes of acute and subacute cough (ie, cough of between 3 and 8 weeks duration),⁵ or the treatment of chronic cough. Because cough is one of the most common complaints for which patients seek medical attention and health-care expenditures for treating cough are substantial, it is important to publish an up-to-date evidence-based clinical practice guideline for diagnosing and treating cough in adult and pediatric populations. Because diagnostic and therapeutic recommendations may differ between adult and pediatric populations, especially in patients who are < 15 years of age, clinicians caring for pediatric populations are encouraged to first refer to the pediatric section, and to the pediatric portions of the section on “Habit and Psychogenic Cough.” Because the literature and recommendations in all other sections of this guideline are primarily adult-focused, caution is advised when extrapolating these recommendations to the pediatric populations.

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†This guideline is reviewed on an annual basis. The ACCP Health and Science Policy (HSP) Committee determined that new studies have been published that warrant an update of the chapter/section of the practice guideline. The HSP Committee also determined that the remainder of the chapters/sections does not require updating, and these recommendations remain current.The following chapters need updating:

Assessing Cough Severity and Efficacy of Therapy in Clinical Research
Unexplained (Idiopathic Cough) Chronic Cough
Guidelines for Evaluating Chronic Cough in Pediatrics