CHEST Guidelines-Managing-Chronic-Cough-Due-to-Asthma-and-NAEB-in-A

Managing-Chronic-Cough-Due-to-Asthma-and-NAEB-in-A

Pdf Summary

The CHEST Guideline and Expert Panel Report focuses on managing chronic cough in adults and adolescents due to asthma and non-asthmatic eosinophilic bronchitis (NAEB). The guideline assesses the role of non-invasive airway inflammation measurements, such as induced sputum and fractional exhaled nitric oxide (FENO), and evaluates treatments for cough caused by asthma or NAEB. The report analyzed three systematic reviews comprising randomized controlled trials (RCTs) and observational trials.

Key findings include:

1. <strong>Non-invasive Measurements</strong>: There is moderate evidence suggesting that such measurements can predict a favorable response to corticosteroids in asthma with chronic cough. However, a paucity of studies specifically addressing cough limits robust conclusions.

2. <strong>Asthma-related Cough Management</strong>: Inhaled corticosteroids (ICS) emerge as the primary treatment recommendation, with a suggestion for leukotriene receptor antagonists or increasing ICS dosage if cough persists. Beta-agonists are also considered beneficial.

3. <strong>NAEB-related Cough Management</strong>: ICS are recommended as the first choice. If the response is incomplete, increasing ICS dosage and using a leukotriene inhibitor are suggested.

The guideline highlights existing knowledge gaps and emphasizes the need for more targeted research on chronic cough distinct from other asthma symptoms. It also underscores the necessity of implementing non-invasive tests in clinical practice to confirm NAEB diagnosis. Moreover, there is a lack of robust, cough-specific outcomes in asthma-related RCTs, and current asthma therapies often neglect specific cough-related measures in favor of broader asthma control metrics. Future research should focus on incorporating cough-specific evaluations in clinical trials to validate treatments and determine their impact on cough in both asthma and NAEB.

Keywords

chronic cough

asthma

non-asthmatic eosinophilic bronchitis

NAEB

non-invasive measurements

induced sputum

fractional exhaled nitric oxide

inhaled corticosteroids

leukotriene receptor antagonists

beta-agonists