Usefulness of CHEST 2006 Cough Classifications

The 2006 CHEST cough guidelines may be a useful management algorithm in diagnosing and treating patients with cough, according to a systematic review published in the journal CHEST. 

The study investigators performed a systematic review of the literature to assess the usefulness of the CHEST 2006 classifications of acute, subacute, and chronic cough. They sought to determine whether the guidelines predicted the most common causes of cough for each category accurately and to assign grades based on strengths of recommendations produced from the review.

Study data for all 3 types of cough were derived from studies performed on a total of 4 continents (North America, South America, Europe, and Asia). A review of the literature found that the 2006 CHEST management algorithms for acute, subacute, and chronic cough are useful in treating adult patients globally. As a result, the algorithms have been updated to reflect the advances in cough management in recent literature.

The following are the summary of suggestions made:

1. For adult patients complaining of cough, we suggest that acute cough be defined as being less than 3 weeks in duration (Grade 2C).

2. For adult patients complaining of cough, we suggest that subacute cough be defined as being between 3 and 8 weeks in duration (Grade 2C).

3. For adult patients complaining of cough, we suggest that chronic cough be defined as being greater than 8 weeks in duration (Grade 2C).

4. For adult patients seeking medical care complaining of cough, we suggest that estimating the duration of cough is the first step in narrowing the list of potential diagnoses (Grade 2C).

5. For adult patients around the globe complaining of cough, we suggest that the cough be managed using evidence-based guidelines that are based on duration of cough (Grade 2C).

Investigators concluded that the current guidelines and management algorithms for acute, subacute, and chronic cough in adults are useful based on the literature published since the CHEST organization originally released their 2006 guidelines. 

Clinicians are encouraged to continue using the 2006 cough guidelines, as well as to implement the 5 suggestions made in this study as a result of the systematic literature review performed.

Reference

Irwin RS, French CL, Chang AB, Altman KW; on behalf of the CHEST Expert Cough Panel. Classification of cough as a symptom in adults and management algorithms: CHEST guideline and expert panel report [published online on November 9, 2017]. CHEST. doi:10.1016/j.chest.2017.10.016