Allergy Asthma Immunol Res.  2018 Nov;10(6):591-613. 10.4168/aair.2018.10.6.591.

KAAACI Evidence-Based Clinical Practice Guidelines for Chronic Cough in Adults and Children in Korea

Affiliations
  • 1Department of Pediatrics, Korea University College of Medicine and Environmental Health Center for Childhood Asthma, Korea University Anam Hospital, Seoul, Korea.
  • 2Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 3Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.
  • 4Department of Internal Medicine, St. Carollo General Hospital, Suncheon, Korea.
  • 5Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
  • 6Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
  • 7Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
  • 8Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 9Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
  • 10Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.
  • 11Department of Otorhinolaryngology, Gachon University, Gil Medical center, Incheon, Korea.
  • 12Department of Internal Medicine, Seoul National University Bundang Hospital, Bundang, Korea.
  • 13Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea.
  • 14Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
  • 15Institute for Evidence-based Medicine Cochrane Korea, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
  • 16Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea.
  • 17Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 18Woori Pediatric Clinic, Goyang, Korea.
  • 19Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 20Respiratory and Allergy Clinic, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 21GF Internal Medicine Allergy Clinic, Seoul, Korea.
  • 22Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.
  • 23Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea.
  • 24Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Dongtan, Korea.
  • 25Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
  • 26Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
  • 27Department of Internal medicine, Yeungnam University College of Medicine, Daegu, Korea.
  • 28Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea.
  • 29Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
  • 30Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 31Department of Internal Medicine, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea. ksh1134@eulji.ac.kr
  • 32Department of Pediatrics, Inha University School of Medicine and Environmental Health Center for Allergic Disease, Inha University Hospital, Incheon, Korea. dhyunlim@inha.ac.kr

Abstract

Chronic cough is common in the community and causes significant morbidity. Several factors may underlie this problem, but comorbid conditions located at sensory nerve endings that regulate the cough reflex, including rhinitis, rhinosinusitis, asthma, eosinophilic bronchitis, and gastroesophageal reflux disease, are considered important. However, chronic cough is frequently non-specific and accompanied by not easily identifiable causes during the initial evaluation. Therefore, there are unmet needs for developing empirical treatment and practical diagnostic approaches that can be applied in primary clinics. Meanwhile, in referral clinics, a considerable proportion of adult patients with chronic cough are unexplained or refractory to conventional treatment. The present clinical practice guidelines aim to address major clinical questions regarding empirical treatment, practical diagnostic tools for non-specific chronic cough, and available therapeutic options for chronic wet cough in children and unexplained chronic cough in adults in Korea.

Keyword

Cough; guideline; evidence-based medicine

MeSH Terms

Adult*
Asthma
Bronchitis
Child*
Cough*
Eosinophils
Evidence-Based Medicine
Gastroesophageal Reflux
Humans
Korea*
Referral and Consultation
Reflex
Rhinitis
Sensory Receptor Cells

Figure

  • Fig. 1 Overview of clinical approaches for the treatment of chronic cough in Korean patients.The initial investigation includes a comprehensive medical history, physical examination, chest X-rays, and/or spirometry (when available). If the cough is non-specific, objective tests for steroid-responsive cough and empirical trials are recommended. When clues suggest specific cough conditions, specific management should be followed. If cough remains unexplained after thorough investigation and therapeutic trials in adults, further pharmacological and non-pharmacological options are recommended to control cough.ACEi, angiotensin converting enzyme inhibitors; GERD, gastroesophageal reflux disease; COPD, chronic obstructive pulmonary disease.

  • Fig. 2 Approach for non-specific chronic cough in Korean adults (age ≥ 15 years).Decision for empirical treatment and diagnostic tests may depend on clinical and instrument settings. Patients with chronic cough unresponsive to empirical trials or specific treatment should be referred to specialist centers for further diagnostic tests and therapeutic trials. If cough is still unexplained, pharmacological and non-pharmacological treatment options are considered to control cough.H1RA, histamine-1 receptor antagonist; ICS, inhaled corticosteroid; PPI, proton-pump inhibitor; GERD, gastroesophageal reflux disease.Asterisk (*) indicates the drug (or test) of interest in the present guidelines.

  • Fig. 3 Approach for non-specific chronic cough and chronic wet cough in Korean children (age < 15 years). Decision for empirical treatment and diagnostic tests may depend on clinical and instrument settings. Children with chronic cough unresponsive to empirical trials or specific treatment should be referred to specialist centers for further diagnostic tests and therapeutic trials.ICS, inhaled corticosteroid; H1RA, histamine-1 receptor antagonist.Asterisk (*) indicates the drug (or test) of interest in the present guidelines.


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