Revised Korean Cough Guidelines, 2020: Recommendations and Summary Statements

Abstract

Cough is the most common respiratory symptom that can have various causes. It is a major clinical problem that can reduce a patient's quality of life. Thus, clinical guidelines for the treatment of cough were established in 2014 by the cough guideline committee under the Korean Academy of Tuberculosis and Respiratory Diseases. From October 2018 to July 2020, cough guidelines were revised by members of the committee based on the first guidelines. The purpose of these guidelines is to help clinicians efficiently diagnose and treat patients with cough. This article highlights the recommendations and summary of the revised Korean cough guidelines. It includes a revised algorithm for the evaluation of acute, subacute, and chronic cough. For a chronic cough, upper airway cough syndrome (UACS), cough variant asthma (CVA), and gastroesophageal reflux disease (GERD) should be considered in differential diagnoses. If UACS is suspected, first-generation antihistamines and nasal decongestants can be used empirically. In cases with CVA, inhaled corticosteroids are recommended to improve cough. In patients with suspected chronic cough due to symptomatic GERD, proton pump inhibitors are recommended. Chronic bronchitis, bronchiectasis, bronchiolitis, lung cancer, aspiration, intake of angiotensin-converting enzyme inhibitor, intake of dipeptidyl peptidase-4 inhibitor, habitual cough, psychogenic cough, interstitial lung disease, environmental and occupational factors, tuberculosis, obstructive sleep apnea, peritoneal dialysis, and unexplained cough can also be considered as causes of a chronic cough. Chronic cough due to laryngeal dysfunction syndrome has been newly added to the guidelines.

Keywords: Cough; Guideline; Korea.

Fig. 1.

Algorithm for the evaluation of an acute cough. BDR: bronchodilator response; CT: computed tomography; PFT: pulmonary function test.

Fig. 2.

Algorithm for the evaluation of subacute cough. BDR: bronchodilator response; CT: computed tomography; PFT: pulmonary function test; PNS: paranasal sinus; URI: upper respiratory infection.

Fig. 3.

Algorithm for the evaluation of chronic cough. ACEI: angiotensin-converting enzyme inhibitor; BDR: bronchodilator response; CT: computed tomography; CVA: cough variant asthma; DPP4I: dipeptidylpeptidase-4 inhibitor; EB: eosinophilic bronchitis; FeNO: fractional exhaled nitric oxide; GERD: gastroesophageal reflux disease; PFT: pulmonary function test; PND: postnasal drip; PNS: paranasal sinus; UACS: upper airway cough syndrome.