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ERS guidelines on the diagnosis and treatment of chronic cough in adults and children

Morice, Alyn H.; Millqvist, Eva; Bieksiene, Kristina; Birring, Surinder S.; Dicpinigaitis, Peter; Ribas, Christian Domingo; Boon, Michele Hilton; Kantar, Ahmad; Lai, Kefang; McGarvey, Lorcan; Rigau, David; Satia, Imran; Smith, Jacky; Song, Woo-Jung; Tonia, Thomy; van den Berg, Jan W. K.; van Manen, Mirjam J. G.; Zacharasiewicz, Angela

Authors

Alyn H. Morice

Eva Millqvist

Kristina Bieksiene

Surinder S. Birring

Peter Dicpinigaitis

Christian Domingo Ribas

Michele Hilton Boon

Ahmad Kantar

Kefang Lai

Lorcan McGarvey

David Rigau

Imran Satia

Jacky Smith

Woo-Jung Song

Thomy Tonia

Jan W. K. van den Berg

Mirjam J. G. van Manen

Angela Zacharasiewicz



Abstract

These guidelines incorporate the recent advances in chronic cough pathophysiology, diagnosis and treatment. The concept of cough hypersensitivity has allowed an umbrella term that explains the exquisite sensitivity of patients to external stimuli such a cold air, perfumes, smoke and bleach. Thus adults with chronic cough now have a firm physical explanation for their symptoms based on vagal afferent hypersensitivity. Different treatable traits exist with cough variant asthma/eosinophilic bronchitis responding to anti inflammatory treatment and non acid reflux being treated with promotility agents rather the anti acid drugs. An alternative antitussive strategy is to reduce hypersensitivity by neuromodulation. Low dose morphine is highly effective in a subset of patients with cough resistant to other treatments. Gabapentin and pregabalin are also advocated but in clinical experience they are limited by adverse events. Perhaps the most promising future developments in pharmacotherapy are drugs which tackle neuronal hypersensitivity by blocking excitability of afferent nerves by inhibiting targets such as the ATP receptor (P2X3). Finally cough suppression therapy when performed by competent practitioners can be highly effective. Children are not small adults and a pursuit of an underlying cause for cough is advocated. Thus in toddlers inhalation of a foreign body is common. Persistent bacterial bronchitis is a common and previously unrecognised cause of wet cough in children. Antibiotics, (which, dose, and duration need to be determined) can be curative. Paediatric specific algorithm should be used.

Journal Article Type Article
Journal European respiratory journal
Print ISSN 0903-1936
Electronic ISSN 1399-3003
Publisher European Respiratory Society
Peer Reviewed Peer Reviewed
APA6 Citation Morice, A. H., Millqvist, E., Bieksiene, K., Birring, S. S., Dicpinigaitis, P., Ribas, C. D., …Zacharasiewicz, A. (in press). ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. The European respiratory journal, https://doi.org/10.1183/13993003.01136-2019
DOI https://doi.org/10.1183/13993003.01136-2019
Keywords Pulmonary and Respiratory Medicine
Publisher URL https://erj.ersjournals.com/content/early/2019/09/02/13993003.01136-2019
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