CHESTThought Leader BlogMuch Ado About Cough

Much Ado About Cough

Dr. IrwinBy Richard S. Irwin, MD, Master FCCP 

Cough is one of the most common health-care problems, and it is an expensive one. In 2013, consumers spent approximately $6.8 billion in the United States, approximately $88 million in Australia, and approximately $101 million in Great Britain according to a survey conducted by the Nielsen Company.

While these numbers are staggering, they do not begin to reflect the total cost spent treating cough. Costs not covered by this survey include physician fees, x-rays, laboratory testing, as well as prescription drug costs for cough-related causes. It also does not cover the cost of time missed from work.

Cough of undifferentiated duration is the single largest complaint for which patients of all ages seek medical treatment in the United States.

Recognizing the importance of cough, the American College of Chest Physicians published the first evidence-based cough guideline in 1998. The second edition was updated in 2006  Since those initial publications, a number of cough guidelines have been published from organizations around the world including Belgium, Brazil, China, Germany, Ireland, Netherlands, Japan, and South Africa.

Cough is one of the most common health-care problems.

Over the next few years, CHEST will periodically update the entire spectrum of topics covered previously in the guideline.  As in the past years, the focus of these updates has been on managing cough as a symptom and when its defense mechanism has been impaired. The updated guidelines have also adhered to the more rigorous, evidence-based standards that have become the norm since the previous guidelines were published. 

In order to cover all topics that clinicians will find useful, even when the strongest evidence was not available, the Expert Cough Panel requested permission from CHEST’s Guidelines Oversight Committee to create a hybrid document. With their approval, this document includes both recommendations for areas supported by strong clinical evidence as well as suggestions derived from consensus statement methodology. 

As a result, the updated Cough Guidelines and Expert Panel Report represents clinically important information generated by the shared efforts of a group of 53 individuals from the fields of adult and pediatric pulmonology and respirology, internal and family medicine, allergy, psychology, neurology, adult and pediatric speech pathology, otolaryngology, gastroenterology, gerontology, infectious disease, nursing, anatomy, physiology, thoracic oncology, palliative care, and pharmacy. 

The first updated paper, Overview to the Management of Cough: Chest Guideline and Expert Panel Report is published in the Online First section of CHEST on July 31, 2014. Watch for other topics over the next few months.

The authors of this article comprise the Executive Committee of the Cough Expert Panel chaired by Dr. Irwin. Dr. Irwin is from the Division of Pulmonary, Allergy and Critical Care Medicine at UMass Memorial Medical Center and the University of Massachusetts Medical School in Worcester, Massachusetts. He is also Editor in Chief of CHEST.