Abstract
In the ever-evolving field of respiratory medicine, the management and understanding of cough have pivotal importance. A comprehensive response published in the Chest journal provides insights into various aspects of diagnosing and treating cough, a common clinical presentation that can stem from various etiologies, ranging from acute infections to chronic pulmonary conditions. This article dissects the response from the CHEST Expert Cough Panel published in Chest (2020), volume 155, pages 1082-1083, and further explores the intricacies of cough management, with additional insights from esteemed respiratory experts.
Introduction
Cough is a defense mechanism but also one of the most frequent reasons for outpatient visits. Its implications on quality of life, healthcare utilization, and economic burden cannot be overstated. Addressing this concern, the CHEST Expert Cough Panel, led by Dr. Adam T. Hill and colleagues, published a significant response in the journal Chest (DOI: 10.1016/j.chest.2019.02.014). This article is a deep dive into the discussions and recommendations that have emerged from the panel’s collaborative effort.
The Response from the CHEST Expert Cough Panel
Published in Chest in May 2019, the response from the CHEST Expert Cough Panel demonstrated a collaborative effort to streamline diagnosis and management strategies for cough. The panel, comprising experts such as Dr. Adam Hill, Dr. Philip Gold, Dr. Ali A. El Solh, Dr. Joshua P. Metlay, and Belinda Ireland, touched upon various critical aspects such as clinical evaluation, the significance of patient history, diagnostic algorithms, and treatment modalities.
The panel emphasized the importance of categorizing cough into acute, subacute, and chronic phases to tailor appropriate management strategies. By reviewing the recent literature and incorporating their clinical expertise, the panelists highlighted the need for more precise diagnostic tools and emphasized tailored therapeutic approaches for conditions like influenza, human-induced cough, and pneumonia.
Etiology and Diagnosis
The underlying causes of cough are multifaceted. The CHEST Expert Cough Panel pointed out that while acute cough is often due to respiratory infections like the common cold or influenza, chronic cough might be attributed to conditions such as asthma, gastroesophageal reflux disease (GERD), or upper airway cough syndrome (UACS). To aid physicians, the panel underlined the importance of comprehensive history-taking and physical examination, supported by investigations like spirometry or chest radiography, as needed.
Management and Therapy
Management of cough involves both non-pharmacological and pharmacological interventions. Panel experts like Dr. Richard S. Irwin espoused approaches that consider the underlying cause of cough. For instance, inhalers containing corticosteroids might be recommended for cough-variant asthma, whereas proton pump inhibitors could be effective for cough associated with GERD. Moreover, the panel discussed novel therapies on the horizon and the importance of evidence-based practice in choosing the right treatment.
Advancements and Future Directions
The response not only delved into the current understanding of cough but also pointed out areas necessitating research. The identification of unique biomarkers for cough, more effective antitussive agents, and the impact of emerging viruses on respiratory health were outlined as priority research domains.
Clinical Implications
This elucidation by the CHEST Expert Cough Panel has critical clinical implications. It not only guides practitioners in the current best practices for cough management but also paves the way for future developments, ensuring improved patient outcomes.
Conclusion
The response issued by the CHEST Expert Cough Panel encapsulates a modern understanding of cough. With nuances in diagnosis, management, and future research directions, this response serves as a cornerstone for current and future physicians in respiratory medicine and patient care.
References
1. Hill, A. T., Gold, P. M., El Solh, A. A., Metlay, J. P., Ireland, B., & Irwin, R. S. (2019). Response. Chest, 155(5), 1082-1083. https://doi.org/10.1016/j.chest.2019.02.014
2. Adams, T. M., Altman, K. W., Azoulay, E., Barker, A. F., Birring, S. S., Blackhall, F., … & Weinberger, M. (2019). CHEST Expert Cough Panel.
3. Irwin, R. S., French, C. T., Lewis, S. Z., Diekemper, R. L., & Gold, P. M. (2020). Overview of the Management of Cough: CHEST Guideline and Expert Panel Report. Chest, 155(1), 155-167. https://doi.org/10.1016/j.chest.2018.08.1034
4. Morice, A. H., Millqvist, E., Bieksiene, K., Birring, S. S., Dicpinigaitis, P., Domingo Ribas, C., … & Tonia, T. (2020). ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. European Respiratory Journal, 55(1), 1901136. https://doi.org/10.1183/13993003.01136-2019
5. Gibson, P., Wang, G., McGarvey, L., Vertigan, A. E., Altman, K. W., Birring, S. S., … & Irwin, R. S. (2020). Treatment of Unexplained Chronic Cough: CHEST Guideline and Expert Panel Report. Chest, 157(1), 169-179. https://doi.org/10.1016/j.chest.2019.07.007
Keywords
1. CHEST Expert Cough Panel
2. Chronic Cough Treatment
3. Acute Cough Management
4. Respiratory Medicine Best Practices
5. Latest Advancements in Cough Research