This is the current release of the guideline.

Definitions for the level of evidence, strength of recommendation, and net benefit follow the "Major Recommendations."

1. In areas where there is a high prevalence of tuberculosis (TB), chronic cough should be defined as it is in the World Health Organization Practical Approach to Lung Health (PAL) program as being 2 to 3 weeks in duration. Level of evidence, low; benefit, substantial; grade of recommendation, B
2. In patients with chronic cough who live in areas with a high prevalence of TB, this diagnosis should be considered, but not to the exclusion of the more common etiologies. Sputum smears and cultures for acid fast bacilli and a chest radiograph should be obtained whenever possible. Level of evidence, low; benefit, substantial; grade of recommendation, B
3. In patients with suspected TB, future investigations are needed to refine the criteria for suspecting TB and initiating a diagnostic evaluation, to utilize resources in a cost-effective manner and to improve patient and caregiver adherence to diagnostic recommendations. Level of evidence, expert opinion; benefit, substantial; grade of recommendation, E/A
4. In populations at increased risk of becoming infected with TB and transmitting it to others by cough (e.g., those persons in prisons and nursing homes), special measures to prevent outbreaks must be made by public health agencies to screen for new cases, maintain surveillance of existing populations, and establish effective diagnostic and treatment programs early in the evaluation. Level of evidence, good; benefit, substantial; grade of recommendation, A
5. In patients with unexplained chronic cough who have resided in areas of endemic infection with fungi or parasites, a diagnostic evaluation for these pathogens should be undertaken when more common causes of cough have been ruled out. Level of evidence, low; benefit, substantial; grade of recommendation, B

Definitions:

Quality of the Evidence

Good = evidence is based on good randomized controlled trials (RCTs) or meta-analyses

Fair = evidence is based on other controlled trials or RCTs with minor flaws

Low = evidence is based on nonrandomized, case-control, or other observational studies

Expert opinion = evidence is based on the consensus of the carefully selected panel of experts in the topic field. There are no studies that meet the criteria for inclusion in the literature review.

Strength of Recommendations

A = strong recommendation

B = moderate recommendation

C = weak recommendation

D = negative recommendation

I = no recommendation possible (inconclusive)

E/A = strong recommendation based on expert opinion only

E/B = moderate recommendation based on expert opinion only

E/C = weak recommendation based on expert opinion only

E/D = negative recommendation based on expert opinion only

Net Benefit

Substantial = There is evidence of benefit that clearly exceeds the minimum clinically significant benefit and evidence of little harm

Intermediate = Clear evidence of benefit but with some evidence of harms, with a net benefit between that defined for "substantial" and "small/weak"

Small/weak = There is evidence of a benefit that may not clearly exceed the minimum clinically significant benefit, or there is evidence of harms that substantially reduce (but do not eliminate) the benefit such that it may not clearly exceed the minimum clinically significant benefit

None = Evidence shows that either there is no benefit or the benefits equal the harms

Conflicting = Evidence is inconsistent with regard to benefits and/or harms such that the net benefit is uncertain

Negative = Expected harms exceed the expected benefits to the population

Table: Relationship of Strength of the Recommendations Scale to Quality of Evidence and Net Benefits

The following clinical algorithms are provided in the section titled "Diagnosis and Management of Cough Executive Summary" (see "Availability of Companion Documents" field)"

• Acute cough algorithm for the management of patients >15 years of age with cough lasting <3 weeks
• Subacute cough algorithm for the management of patients >15 years of age with cough lasting 3 to 8 weeks
• Chronic cough algorithm for the management of patients >15 years of age with cough lasting >8 weeks
• Approach to a child <15 years of age with chronic cough
• Approach to a child <14 years of age with chronic specific cough

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Not applicable: The guideline was not adapted from another source.

2006 Jan

American College of Chest Physicians - Medical Specialty Society

American College of Chest Physicians

American College of Chest Physicians (ACCP) Expert Panel on the Diagnosis and Management of Cough

Primary Author: Mark J. Rosen, MD, FCCP

Panel Members: Richard S. Irwin, MD, FCCP (Chair); Michael H. Baumann, MD, FCCP (HSP Liaison); Donald C. Bolser, PhD; Louis-Philippe Boulet, MD, FCCP (CTS Representative); Sidney S. Braman, MD, FCCP; Christopher E. Brightling, MBBS, FCCP; Kevin K. Brown, MD, FCCP; Brendan J. Canning, PhD; Anne B. Chang, MBBS, PhD; Peter V. Dicpinigaitis, MD, FCCP; Ron Eccles, DSc; W. Brendle Glomb, MD, FCCP; Larry B. Goldstein, MD; LeRoy M. Graham, MD, FCCP; Frederick E. Hargreave, MD; Paul A. Kvale, MD, FCCP; Sandra Zelman Lewis, PhD; F. Dennis McCool, MD, FCCP; Douglas C. McCrory, MD, MHSc; Udaya B.S. Prakash, MD, FCCP; Melvin R. Pratter, MD, FCCP; Mark J. Rosen, MD, FCCP; Edward Schulman, MD, FCCP (ATS Representative); John Jay Shannon, MD, FCCP (ACP Representative); Carol Smith Hammond, PhD and Susan M. Tarlo, MBBS, FCCP

American Thoracic Society - Medical Specialty Society
Canadian Thoracic Society - Medical Specialty Society

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI on May 4, 2006. The information was verified by the guideline developer on June 5, 2006.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.