World Allergy Organization Journal (May 2022)
WAO-ARIA consensus on chronic cough – Part III: Management strategies in primary and cough-specialty care. Updates in COVID-19
- Philip W. Rouadi, MD,
- Samar A. Idriss, MD,
- Jean Bousquet, MD, PhD,
- Tanya M. Laidlaw, MD,
- Cecilio R. Azar, MD,
- Mona S. Al-Ahmad, MD, FRCPCP,
- Anahi Yañez, MD,
- Maryam Ali Y. Al-Nesf, MD, MSc R, CABHS,
- Talal M. Nsouli, MD, FACAAI, FAAAAI,
- Sami L. Bahna, MD, DrPH,
- Eliane Abou-Jaoude, MD,
- Fares H. Zaitoun, MD, FACAAI,
- Usamah M. Hadi, MD, FACS, ERS, PARS,
- Peter W. Hellings, MD, PhD,
- Glenis K. Scadding, MD, FRCP,
- Peter K. Smith, BMedSci, MBBS, FRACP, PhD,
- Mario Morais-Almeida, MD,
- René Maximiliano Gómez, MD, PhD,
- Sandra N. Gonzalez Diaz, MD, PhD,
- Ludger Klimek, MD, PhD,
- Georges S. Juvelekian, MD, FCCP, D’ABSM,
- Moussa A. Riachy, MD, FCCP,
- Giorgio Walter Canonica, MD,
- David Peden, MD,
- Gary W.K. Wong, MD,
- James Sublett, MD,
- Jonathan A. Bernstein, MD,
- Lianglu Wang, MD,
- Luciana K. Tanno, MD, PhD,
- Manana Chikhladze, PhD,
- Michael Levin, MD,
- Yoon-Seok Chang, MD, PhD,
- Bryan L. Martin, DO,
- Luis Caraballo, MD, PhD,
- Adnan Custovic, MD, PhD,
- Jose Antonio Ortego-Martell, MD,
- Olivia J.Ly Lesslar, MBBS BIR,
- Erika Jensen-Jarolim, MD,
- Motohiro Ebisawa, MD,
- Alessandro Fiocchi, MD,
- Ignacio J. Ansotegui, MD, PhD
Affiliations
- Philip W. Rouadi, MD
- Department of Otolaryngology – Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon; Ear, Nose and Throat Department, Dar Al Shifa Hospital, Hawally, Kuwait
- Samar A. Idriss, MD
- Department of Otolaryngology – Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon; Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Lyon, France; Corresponding author
- Jean Bousquet, MD, PhD
- Hospital Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Dermatology and Allergy, Comprehensive Allergy Center, Berlin Institute of Health, Berlin, Germany; Macvia France, Montpellier France; Université Montpellier, Montpellier, France
- Tanya M. Laidlaw, MD
- Department of Medicine, Harvard Medical School, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital Boston, Massachusetts, USA
- Cecilio R. Azar, MD
- Department of Gastroenterology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon; Department of Gastroenterology, Middle East Institute of Health (MEIH), Beirut, Lebanon; Department of Gastroenterology, Clemenceau Medical Center (CMC), Beirut, Lebanon
- Mona S. Al-Ahmad, MD, FRCPCP
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
- Anahi Yañez, MD
- INAER - Investigaciones en Alergia y Enfermedades Respiratorias, Buenos Aires, Argentina
- Maryam Ali Y. Al-Nesf, MD, MSc R, CABHS
- Allergy and Immunology Section, Department of Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
- Talal M. Nsouli, MD, FACAAI, FAAAAI
- International Cough Institute, Washington, DC, USA
- Sami L. Bahna, MD, DrPH
- Allergy & Immunology Section, Louisiana State University Health Sciences Center, Shreveport, LA, USA
- Eliane Abou-Jaoude, MD
- International Cough Institute, Washington, DC, USA
- Fares H. Zaitoun, MD, FACAAI
- Department of Allergy Otolaryngology, LAU-RIZK Medical Center, Beirut, Lebanon
- Usamah M. Hadi, MD, FACS, ERS, PARS
- Clinical Professor Department of Otolaryngology Head and Neck Surgery, American University of Beirut, Lebanon
- Peter W. Hellings, MD, PhD
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology, Leuven, Belgium; University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium; University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium; Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, the Netherlands
- Glenis K. Scadding, MD, FRCP
- Department of ENT, RNENT Hospital, London, UK
- Peter K. Smith, BMedSci, MBBS, FRACP, PhD
- Clinical Medicine Griffith University, Southport Qld, 4215, Australia
- Mario Morais-Almeida, MD
- Allergy Center, CUF Descobertas Hospital, Lisboa, Portugal
- René Maximiliano Gómez, MD, PhD
- School of Health Sciences, Catholic University of Salta, Argentina
- Sandra N. Gonzalez Diaz, MD, PhD
- Universidad Autónoma de Nuevo León, Hospital Universitario and Facultad de Medicina, Monterrey, Nuevo León, Mexico
- Ludger Klimek, MD, PhD
- Center for Rhinology and Allergology, Wiesbaden, Germany
- Georges S. Juvelekian, MD, FCCP, D’ABSM
- Department of Pulmonary, Critical Care and Sleep Medicine at Saint George Hospital University Medical Center, Beirut, Lebanon
- Moussa A. Riachy, MD, FCCP
- Department of Pulmonary and Critical Care, Hôtel-Dieu de France university Hospital, Beirut, Lebanon
- Giorgio Walter Canonica, MD
- Humanitas University & Personalized Medicine Asthma & Allergy Clinic-Humanitas Research Hospital-IRCCS-Milano Italy
- David Peden, MD
- UNC Center for Environmental Medicine, Asthma, and Lung Biology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics UNC School of Medicine, USA
- Gary W.K. Wong, MD
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China
- James Sublett, MD
- Department of Pediatrics, Section of Allergy and Immunology, University of Louisville School of Medicine, 9800 Shelbyville Rd, Louisville, KY, USA
- Jonathan A. Bernstein, MD
- University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, OH, USA
- Lianglu Wang, MD
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China
- Luciana K. Tanno, MD, PhD
- Université Montpellier, Montpellier, France; Desbrest Institute of Epidemiology and Public Health, UMR UA-11, INSERM University of Montpellier, Montpellier, France; WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
- Manana Chikhladze, PhD
- Medical Faculty at Akaki Tsereteli State University, National Institute of Allergy, Asthma & Clinical Immunology, KuTaisi, Tskaltubo, Georgia
- Michael Levin, MD
- Division of Paediatric Allergology, Department of Paediatrics, University of Cape Town, South Africa
- Yoon-Seok Chang, MD, PhD
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
- Bryan L. Martin, DO
- Department of Otolaryngology, Division of Allergy & Immunology, The Ohio State University, Columbus, OH, USA
- Luis Caraballo, MD, PhD
- Institute for Immunological Research, University of Cartagena. Cartagena de Indias, Colombia
- Adnan Custovic, MD, PhD
- National Heart and Lund Institute, Imperial College London, UK
- Jose Antonio Ortego-Martell, MD
- Health Science Institute, Autonomous University of Hidalgo, México
- Olivia J.Ly Lesslar, MBBS BIR
- LifeSpan Medicine, Santa Monica, LA, USA
- Erika Jensen-Jarolim, MD
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Austria; The interuniversity Messerli Research Institute, Medical University Vienna and University of Veterinary Medicine, Vienna, Austria
- Motohiro Ebisawa, MD
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
- Alessandro Fiocchi, MD
- Translational Pediatric Research Area, Allergic Diseases Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Holy See
- Ignacio J. Ansotegui, MD, PhD
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
- Journal volume & issue
-
Vol. 15,
no. 5
p. 100649
Abstract
Background: Chronic cough management necessitates a clear integrated care pathway approach. Primary care physicians initially encounter the majority of chronic cough patients, yet their role in proper management can prove challenging due to limited access to advanced diagnostic testing. A multidisciplinary approach involving otolaryngologists and chest physicians, allergists, and gastroenterologists, among others, is central to the optimal diagnosis and treatment of conditions which underly or worsen cough. These include infectious and inflammatory, upper and lower airway pathologies, or gastro-esophageal reflux. Despite the wide armamentarium of ancillary testing conducted in cough multidisciplinary care, such management can improve cough but seldom resolves it completely. This can be due partly to the limited data on the role of tests (eg, spirometry, exhaled nitric oxide), as well as classical pharmacotherapy conducted in multidisciplinary specialties for chronic cough. Other important factors include presence of multiple concomitant cough trigger mechanisms and the central neuronal complexity of chronic cough. Subsequent management conducted by cough specialists aims at control of cough refractory to prior interventions and includes cough-specific behavioral counseling and pharmacotherapy with neuromodulators, among others. Preliminary data on the role of neuromodulators in a proof-of-concept manner are encouraging but lack strong evidence on efficacy and safety. Objectives: The World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough reviewed the recent literature on management of chronic cough in primary, multidisciplinary, and cough-specialty care. Knowledge gaps in diagnostic testing, classical and neuromodulator pharmacotherapy, in addition to behavioral therapy of chronic cough were also analyzed. Outcomes: This third part of the WAO/ARIA consensus on chronic cough suggests a management algorithm of chronic cough in an integrated care pathway approach. Insights into the inherent limitations of multidisciplinary cough diagnostic testing, efficacy and safety of currently available antitussive pharmacotherapy, or the recently recognized behavioral therapy, can significantly improve the standards of care in patients with chronic cough.
