Treatment of unexplained chronic cough: CHEST guideline and expert panel report

Gibson, Peter, Wang, Gang, McGarvey, Lorcan, Vertigan, Anne E., Altman, Kenneth W., Birring, Surinder S., CHEST Expert Cough Panel, Mazzone, Stuart and Newcombe, Peter (2016) Treatment of unexplained chronic cough: CHEST guideline and expert panel report. Chest, 149 1: 27-44. doi:10.1378/chest.15-1496

Author Gibson, Peter
Wang, Gang
McGarvey, Lorcan
Vertigan, Anne E.
Altman, Kenneth W.
Birring, Surinder S.
CHEST Expert Cough Panel
Mazzone, Stuart
Newcombe, Peter
Title Treatment of unexplained chronic cough: CHEST guideline and expert panel report
Journal name Chest   Check publisher's open access policy
ISSN 1931-3543
Publication date 2016-01-06
Year available 2016
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1378/chest.15-1496
Open Access Status Not Open Access
Volume 149
Issue 1
Start page 27
End page 44
Total pages 18
Place of publication Glenview, IL United States
Publisher American College of Chest Physicians
Collection year 2017
Language eng
Formatted abstract

Unexplained chronic cough (UCC) causes significant impairments in quality of life. Effective assessment and treatment approaches are needed for UCC.


This systematic review of randomized controlled trials (RCTs) asked: What is the efficacy of treatment compared with usual care for cough severity, cough frequency, and cough-related quality of life in patients with UCC? Studies of adults and adolescents aged > 12 years with a chronic cough of > 8 weeks’ duration that was unexplained after systematic investigation and treatment were included and assessed for relevance and quality. Based on the systematic review, guideline suggestions were developed and voted on by using the American College of Chest Physicians organization methodology.


Eleven RCTs and five systematic reviews were included. The 11 RCTs reported data on 570 participants with chronic cough who received a variety of interventions. Study quality was high in 10 RCTs. The studies used an assortment of descriptors and assessments to identify UCC. Although gabapentin and morphine exhibited positive effects on cough-related quality of life, only gabapentin was supported as a treatment recommendation. Studies of inhaled corticosteroids (ICS) were affected by intervention fidelity bias; when this factor was addressed, ICS were found to be ineffective for UCC. Esomeprazole was ineffective for UCC without features of gastroesophageal acid reflux. Studies addressing nonacid gastroesophageal reflux disease were not identified. A multimodality speech pathology intervention improved cough severity.


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.
Keyword Chronic cough
Cough frequency and severity
Cough-related quality of life
Unexplained cough
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: HERDC Pre-Audit
School of Biomedical Sciences Publications
School of Psychology Publications
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Citation counts: TR Web of Science Citation Count  Cited 6 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 6 times in Scopus Article | Citations
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Created: Fri, 19 Feb 2016, 14:54:08 EST by Dr Stuart Mazzone on behalf of School of Biomedical Sciences