In search for the Holy Grail of cough guidelines

Anne B. Chang


Cough of all types and duration (acute and chronic), a common reason for acute presentations to medical practitioners, is a burden of disease across the pediatric (1,2) and adult (3) ages and across countries (4). A recent study in children found that parents sought multiple consultations (~75% had seen a doctor >5 times) for their child’s cough prior to appropriate management (5). In an attempt to improve the management of cough, the concept of using a guideline for cough was first initiated by Dr. Irwin in the 1990s (6). Now, there are many guidelines on the management of cough in children and adults (7). Those accustomed to evidence based medicine are cognisant of the relative paucity of studies to inform these evidence-based guidelines on the management of chronic cough. This was highlighted by some but not all of these guidelines and now confirmed through the analyses undertaken by Jiang and colleagues (7), the first study to compare the different cough guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) tool. While the analyses were done well, it included studies from a decade ago and during this period, major changes in the field of guideline development and evaluation has occurred.