The Korean Cough Guideline: Recommendation and Summary Statement

Abstract

Cough is one of the most common symptom of many respiratory diseases. The Korean Academy of Tuberculosis and Respiratory Diseases organized cough guideline committee and cough guideline was developed by this committee. The purpose of this guideline is to help clinicians to diagnose correctly and treat efficiently patients with cough. In this article, we have stated recommendation and summary of Korean cough guideline. We also provided algorithm for acute, subacute, and chronic cough. For chronic cough, upper airway cough syndrome (UACS), cough variant asthma (CVA), and gastroesophageal reflux disease (GERD) should be considered. If UACS is suspicious, first generation anti-histamine and nasal decongestant can be used empirically. In CVA, inhaled corticosteroid is recommended in order to improve cough. In GERD, proton pump inhibitor is recommended in order to improve cough. Chronic bronchitis, bronchiectasis, bronchiolitis, lung cancer, aspiration, angiotensin converting enzyme inhibitor, habit, psychogenic cough, interstitial lung disease, environmental and occupational factor, tuberculosis, obstructive sleep apnea, peritoneal dialysis, and idiopathic cough can be also considered as cause of chronic cough. Level of evidence for treatment is mostly low. Thus, in this guideline, many recommendations are based on expert opinion. Further study regarding treatment for cough is mandatory.

Keywords: Cough; Guideline; Korean.

Figure 1. Algorithm for evaluation of acute cough. ^*If symptom maintains, follow algorithm for subacute and chronic cough evaluation. ^†May consider empirical therapy when evaluation is not possible. PNS: paranasal sinus; PFT: pulmonary function test; BDR: bronchodilator response; CT: computed tomography.

Figure 2. Algorithm for evaluation of subacute cough. ^*When clinical manifestations are suspicious of Bordetella pertussis or Mycoplasma infection, evaluation and treatment can be performed to these pathogens.

Figure 3. Algorithm for evaluation of chronic cough. ^*When clinical manifestation is suspicious for UACS, empirical treatment can be tried even if PNS X-ray is normal. ^†Empirical treatment can be considered when evaluation is not feasible. ACEI: angiotensin converting enzyme inhibitor; PND: postnasal drip; PNS: paranasal sinus; UACS: upper airway cough syndrome; PFT: pulmonary function test; BDR: bronchodilator response; CVA: cough variant asthma; EB: eosinophilic bronchitis; GERD: gastroesophageal reflux disease; CT: computed tomography.