Unexplained (Idiopathic) Cough: ACCP Evidence-Based Clinical Practice Guidelines

doi:10.1378/chest.129.1_suppl.220S

Chest

Volume 129, Issue 1, Supplement, January 2006, Pages 220S-221S

https://doi.org/10.1378/chest.129.1_suppl.220S Get rights and content

Objective:

To review the literature on unexplained cough, previously referred to as idiopathic cough.

Methods:

Search of MEDLINE (through May 2004) for studies published in the English language since 1980 on human subjects using the medical subject heading terms “cough,” “unexplained cough,” and “idiopathic cough.” We selected case series and prospective descriptive clinical trials. We also obtained any references from these studies that were pertinent to the topic.

Results:

The diagnosis of unexplained (idiopathic) cough should only be considered after a thorough diagnostic and treatment approach for the most common causes of cough has been completed and uncommon causes have been adequately evaluated Unless this is done, it is likely that many patients with a definable cause of cough will be misdiagnosed as having “unexplained cough.”

Conclusion:

The diagnosis of unexplained cough is probably made too often based on an inadequate diagnostic workup or treatment course to determine the specific cause of cough. Nevertheless, there may be a group of patients in whom none of the usual explanations for cough may be present. For this group, the committee unanimously recommends using the diagnostic term unexplained cough, rather than idiopathic cough.

REFERENCES (10)

SS Birring et al.
Idiopathic chronic cough and organ-specific autoimmune diseases: a case-control study
Respir Med
(2004)
SY Lee et al.
Airway inflammation as an assessment of chronic nonproductive cough
Chest
(2001)
PV Dicpinigaitis et al.
The influence of gender on cough reflex sensitivity
Chest
(1998)
RS Irwin et al.
Chronic cough: the spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy
Am Rev Respir Dis
(1990)
RS Irwin et al.
Chronic persistent cough in the adult: the spectrum and frequency of causes and successful outcome of specific therapy
Am Rev Respir Dis
(1981)

There are more references available in the full text version of this article.

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The evidence supporting the diagnosis and management of UCC is limited. UCC requires further study to establish agreed terminology and the optimal methods of investigation using established criteria for intervention fidelity. Speech pathology-based cough suppression is suggested as a treatment option for UCC. This guideline presents suggestions for diagnosis and treatment based on the best available evidence and identifies gaps in our knowledge as well as areas for future research.

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Chest

SupplementDiagnosis and Management of Cough: ACCP Evidence-Based Clinical Practice GuidelinesUnexplained (Idiopathic) Cough: ACCP Evidence-Based Clinical Practice Guidelines

Objective:

Methods:

Results:

Conclusion:

Respir Med

Chest

Chest

Chronic cough: the spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy

Am Rev Respir Dis

Chronic persistent cough in the adult: the spectrum and frequency of causes and successful outcome of specific therapy

Am Rev Respir Dis

Supplement
Diagnosis and Management of Cough: ACCP Evidence-Based Clinical Practice Guidelines
Unexplained (Idiopathic) Cough: ACCP Evidence-Based Clinical Practice Guidelines