British Thoracic Society Clinical Statement on Chronic Cough in Adults

Introduction

• Chronic cough (CC) is common, affecting middle-aged females predominantly, and is associated with significantly impaired quality of life (QoL) and increased healthcare costs.
• Recent advances in diagnosis and management have not been widely adopted in clinical practice in the UK.

Terminology, Epidemiology, and Impact

• CC is defined as cough lasting over 8 weeks, while acute cough lasts up to 3 weeks.
• The prevalence of CC is estimated to be around 1.2% to 2% of the population, with factors such as smoking, airway diseases, obesity, reflux, rhinitis, and ACE inhibitor use associated with its development.
• The impact of CC on QoL is comparable to conditions like chronic obstructive pulmonary disease (COPD), with patients experiencing various symptoms and psychological distress.

Clinical Assessment

• A systematic approach to CC management is outlined, with most patients being treated in primary care.
• Key aspects of clinical assessment include identifying potential underlying diseases and treatable traits, conducting a thorough history and examination, and performing basic investigations such as chest X-ray, full blood count, spirometry, and fractional exhaled nitric oxide (FeNO) measurement.

Treatable Traits in Cough

• The term 'treatable trait' is used to describe conditions that may cause cough, such as smoking, ACE inhibitor use, airway disease, productive cough, eosinophilic airway disease, gastro-oesophageal reflux disease, upper airway symptoms, obstructive sleep apnoea, and obesity.
• Each trait has specific identification markers and treatment recommendations, with the goal of optimizing treatment based on individual characteristics.

Management of Chronic Cough Hypersensitivity

• Cough hypersensitivity is recognized as a treatable trait and requires specific treatment, including antitussives and non-pharmacological interventions.
• Novel therapies targeting cough hypersensitivity, such as P2X3 antagonists, are under development and show promise.

Complications of Chronic Cough

• Chronic cough can lead to complications such as urinary incontinence (UI) and cough syncope, which can have significant impacts on QoL and safety.

Delivery of Care for Chronic Cough

• Care for patients with CC is multidisciplinary and can be effectively managed in primary or secondary care settings.
• Setting up secondary care cough clinics and providing access to specialist speech and language therapy and physiotherapy are recommended to improve patient outcomes.

Research and Future Directions

• High-quality evidence for the management of CC is limited, highlighting the need for further research to develop validated tools, optimize non-pharmacological treatments, and identify biomarkers for cough hypersensitivity.
• The development of novel therapies, particularly P2X3 antagonists, holds promise for improving the care of patients with refractory chronic cough (RCC).