Article Abstract

How evidenced based and up to date are our cough guidelines?

Authors: Michael D Shields


Problem coughing is thought to be one of the commonest causes for medical consultations as it generates much anxiety in patients and reduces quality of life. Coughing is an important protective reflex and patients with inadequate cough will experience recurrent chest infections with areas of the lung consolidated and collapsed. Simply trying to suppress coughing is therefore often illogical. However, because coughing is distressful both patients and their doctors feel under pressure to do something resulting in the widespread use of cough medicines many of which, while available over the counter, do not work. It is important that doctors, when faced with a patient with problem coughing, attempt to make a diagnosis so that disease specific treatment if available can be started. Unfortunately, even when a specific diagnosis has been made there is sometimes no effective therapy available. This is true of the prolonged coughing in pertussis in young adults. While doing this the doctor needs to decide whether the patient has features of a serious chronic disease or simply has a transient condition that will almost certainly resolve (e.g., prolonged coughing after an upper respiratory tract infection). The majority of respiratory illnesses are associated with coughing and some extra-pulmonary causes are known to be associated with cough such as gastro-oesophageal reflux, psychogenic cough and external auditory canal wax stimulating Arnold’s reflex. Because there are so many differing causes for cough misdiagnosis is very possible. Given that there are many different causes of coughing of which some are trivial and transient and some coughs may indicate the presence of a serious underlying pathology it is important for doctors to have a structured approach (1). Cough clinical guidelines, therefore, should help busy working clinicians to have an approach to patients who present with problem coughing and their overarching aim is to improve patient care. Cough guidelines should be trust worthy and evidence based, they should be presented in a useable format and highlight areas of uncertainty where further research is needed.