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New recommendations have been unveiled for the diagnosis and management of chronic cough, a condition that affects 8.8% of Australian adults.
Conducting a thorough investigation of a patient’s history of chronic cough and ordering chest x-rays are among the new recommendations in an updated position statement for the diagnosis and management of chronic cough.
A chronic cough is defined as a daily cough of greater than four weeks in children and greater than eight weeks in adults (here).
Cough is the most common symptom leading to medical consultation, write Associate Professor Julie Marchant and her colleagues in the Medical Journal of Australia.
“Chronic cough results in significant health care costs, impairs quality of life and may indicate the presence of a serious underlying condition,” Associate Professor Marchant and colleagues wrote.
Associate Professor Marchant is a paediatric respiratory physician at the Queensland Children’s Hospital and a senior research fellow in the QUT Cough Asthma and Airways Research Group at the Australian Centre for Health Services Innovation (AusHSI).
Prevalence of chronic cough
The prevalence of chronic cough in adults has been estimated to be 9.6% globally and 8.8% in Australia (here and here), with the prevalence of chronic cough gradually increasing to a peak when people are aged in their 60s (here).
The condition is estimated to occur in 3% of people who have never smoked, 4% of people who used to smoke, and 8% of people who currently smoke (here). Overall, chronic cough presents more commonly in middle-aged women (here).
In a recent study of Australian children presenting to emergency departments, 7.5% had chronic cough, and 20–23% had persistent cough at day 28 (here).
The disproportionate burden on Aboriginal and Torres Strait Islander peoples
The prevalence of chronic wet cough in children living in Indigenous communities is around 13% (here).
“First Nations Australians are disproportionately affected by conditions that present with chronic wet cough, such as protracted bacterial bronchitis and bronchiectasis,” wrote Associate Professor Marchant and her colleagues.
“The mortality difference between First Nations and non-First Nations Australians with bronchiectasis is about 22 years (here).”
“In 180 First Nations children aged < 5 years presenting to primary care in urban Queensland for any reason, 24% had a history of chronic cough in the previous 12 months (here).”
A range of causes
The position statement lists a number of causes of paediatric-specific cough, including protracted bacterial bronchitis, asthma, allergic, rhinitis, chronic rhinosinusitis and obstructive sleep apnoea.
Causes of adult chronic cough include asthma, eosinophilic bronchitis, chronic bronchitis, interstitial lung disease and laryngeal hypersensitivity.
“Eosinophilic airway inflammation is found in 30–50% of adults with chronic cough and may reflect asthma, cough variant asthma, and eosinophilic bronchitis,” Associate Professor Marchant and her colleagues wrote.
“Asthma is diagnosed in 24–32% of adults with chronic cough, and is associated with episodic chest tightness, wheeze and dyspnoea.”
“Chronic cough that has been reported in up to 80% of people with interstitial lung disease is often severe, leads to a significantly impaired quality of life, and is associated with worse clinical outcomes.”
Recommendations
Several recommendations for the prevention and management of chronic cough are listed.
“Assessment of children and adults requires a focused history of the chronic cough to elicit any red flag cough pointers that may indicate an underlying disease,” Associate Professor Marchant and her colleagues wrote.
“Further assessment with examination should include a chest x-ray and spirometry (age, > 6 years).
“Separate paediatric and adult diagnostic management algorithms should be followed.”
“[The] management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns,” they wrote.
“Aboriginal and Torres Strait Islander adults and children should be considered high risk groups.”
The authors thanked the Lung Foundation Australia and the Thoracic Society of Australia and New Zealand for their support in the preparation of the guidelines.
Read the position statement in the Medical Journal of Australia or the full statement update