WAO-ARIA consensus on chronic cough - Part III: Management strategies in primary and cough-specialty care. Updates in COVID-19
Philip W Rouadi 1 2, Samar A Idriss 1 3, Jean Bousquet 4 5 6 7, Tanya M Laidlaw 8, Cecilio R Azar 9 10 11, Mona S Al-Ahmad 12, Anahi Yañez 13, Maryam Ali Y Al-Nesf 14, Talal M Nsouli 15, Sami L Bahna 16, Eliane Abou-Jaoude 15, Fares H Zaitoun 17, Usamah M Hadi 18, Peter W Hellings 19 20 21 22, Glenis K Scadding 23, Peter K Smith 24, Mario Morais-Almeida 25, René Maximiliano Gómez 26, Sandra N Gonzalez Diaz 27, Ludger Klimek 28, Georges S Juvelekian 29, Moussa A Riachy 30, Giorgio Walter Canonica 31, David Peden 32, Gary W K Wong 33, James Sublett 34, Jonathan A Bernstein 35, Lianglu Wang 36, Luciana K Tanno 7 37 38, Manana Chikhladze 39, Michael Levin 40, Yoon-Seok Chang 41, Bryan L Martin 42, Luis Caraballo 43, Adnan Custovic 44, Jose Antonio Ortego-Martell 45, Olivia J Ly Lesslar 46, Erika Jensen-Jarolim 47 48, Motohiro Ebisawa 49, Alessandro Fiocchi 50, Ignacio J Ansotegui 51
Affiliations
Affiliations
- Department of Otolaryngology - Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon.
- Ear, Nose and Throat Department, Dar Al Shifa Hospital, Hawally, Kuwait.
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Lyon, France.
- Hospital Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Berlin Institute of Health, Berlin, Germany.
- Macvia France, Montpellier France.
- Université Montpellier, Montpellier, France.
- Department of Medicine, Harvard Medical School, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital Boston, Massachusetts, USA.
- Department of Gastroenterology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon.
- Department of Gastroenterology, Middle East Institute of Health (MEIH), Beirut, Lebanon.
- Department of Gastroenterology, Clemenceau Medical Center (CMC), Beirut, Lebanon.
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.
- INAER - Investigaciones en Alergia y Enfermedades Respiratorias, Buenos Aires, Argentina.
- Allergy and Immunology Section, Department of Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar.
- International Cough Institute, Washington, DC, USA.
- Allergy & Immunology Section, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
- Department of Allergy Otolaryngology, LAU-RIZK Medical Center, Beirut, Lebanon.
- Clinical Professor Department of Otolaryngology Head and Neck Surgery, American University of Beirut, Lebanon.
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology, Leuven, Belgium.
- University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium.
- University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium.
- Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, the Netherlands.
- Department of ENT, RNENT Hospital, London, UK.
- Clinical Medicine Griffith University, Southport Qld, 4215, Australia.
- Allergy Center, CUF Descobertas Hospital, Lisboa, Portugal.
- School of Health Sciences, Catholic University of Salta, Argentina.
- Universidad Autónoma de Nuevo León, Hospital Universitario and Facultad de Medicina, Monterrey, Nuevo León, Mexico.
- Center for Rhinology and Allergology, Wiesbaden, Germany.
- Department of Pulmonary, Critical Care and Sleep Medicine at Saint George Hospital University Medical Center, Beirut, Lebanon.
- Department of Pulmonary and Critical Care, Hôtel-Dieu de France university Hospital, Beirut, Lebanon.
- Humanitas University & Personalized Medicine Asthma & Allergy Clinic-Humanitas Research Hospital-IRCCS-Milano Italy.
- UNC Center for Environmental Medicine, Asthma, and Lung Biology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics UNC School of Medicine, USA.
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China.
- Department of Pediatrics, Section of Allergy and Immunology, University of Louisville School of Medicine, 9800 Shelbyville Rd, Louisville, KY, USA.
- University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, OH, USA.
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China.
- Desbrest Institute of Epidemiology and Public Health, UMR UA-11, INSERM University of Montpellier, Montpellier, France.
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France.
- Medical Faculty at Akaki Tsereteli State University, National Institute of Allergy, Asthma & Clinical Immunology, KuTaisi, Tskaltubo, Georgia.
- Division of Paediatric Allergology, Department of Paediatrics, University of Cape Town, South Africa.
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
- Department of Otolaryngology, Division of Allergy & Immunology, The Ohio State University, Columbus, OH, USA.
- Institute for Immunological Research, University of Cartagena. Cartagena de Indias, Colombia.
- National Heart and Lund Institute, Imperial College London, UK.
- Health Science Institute, Autonomous University of Hidalgo, México.
- LifeSpan Medicine, Santa Monica, LA, USA.
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Austria.
- The interuniversity Messerli Research Institute, Medical University Vienna and University of Veterinary Medicine, Vienna, Austria.
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.
- Translational Pediatric Research Area, Allergic Diseases Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Holy See.
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain.
Abstract
Background: Chronic cough management necessitates a clear integrated care pathway approach. Primary care physicians initially encounter the majority of chronic cough patients, yet their role in proper management can prove challenging due to limited access to advanced diagnostic testing. A multidisciplinary approach involving otolaryngologists and chest physicians, allergists, and gastroenterologists, among others, is central to the optimal diagnosis and treatment of conditions which underly or worsen cough. These include infectious and inflammatory, upper and lower airway pathologies, or gastro-esophageal reflux. Despite the wide armamentarium of ancillary testing conducted in cough multidisciplinary care, such management can improve cough but seldom resolves it completely. This can be due partly to the limited data on the role of tests (eg, spirometry, exhaled nitric oxide), as well as classical pharmacotherapy conducted in multidisciplinary specialties for chronic cough. Other important factors include presence of multiple concomitant cough trigger mechanisms and the central neuronal complexity of chronic cough. Subsequent management conducted by cough specialists aims at control of cough refractory to prior interventions and includes cough-specific behavioral counseling and pharmacotherapy with neuromodulators, among others. Preliminary data on the role of neuromodulators in a proof-of-concept manner are encouraging but lack strong evidence on efficacy and safety.
Objectives: The World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough reviewed the recent literature on management of chronic cough in primary, multidisciplinary, and cough-specialty care. Knowledge gaps in diagnostic testing, classical and neuromodulator pharmacotherapy, in addition to behavioral therapy of chronic cough were also analyzed.
Outcomes: This third part of the WAO/ARIA consensus on chronic cough suggests a management algorithm of chronic cough in an integrated care pathway approach. Insights into the inherent limitations of multidisciplinary cough diagnostic testing, efficacy and safety of currently available antitussive pharmacotherapy, or the recently recognized behavioral therapy, can significantly improve the standards of care in patients with chronic cough.
Keywords: Chronic cough management; Cough primary care; Cough specialty care; Lower airway disease; Neuromodulators; Reflux cough; Speech therapy; Upper airway cough syndrome.
References
https://pubmed.ncbi.nlm.nih.gov/