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

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.

Keywords: Cough; evidence-based medicine; guideline.

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.