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

Managing Chronic Cough Due to Asthma and NAEB in Adults and Adolescents

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The CHEST Guideline and Expert Panel Report addresses the management of chronic cough associated with asthma and non-asthmatic eosinophilic bronchitis (NAEB) in adults and adolescents. Asthma and NAEB are common causes of chronic cough in adults. The guideline explores the role of non-invasive airway inflammation measurements, such as induced sputum and fractional exhaled nitric oxide (FENO), in diagnosing cough related to asthma, and evaluates the best treatment approaches.<br /><br />Systematic reviews of randomized controlled trials (RCTs) and observational studies were conducted, focusing on patients aged 12 and older with chronic cough due to asthma or NAEB. Despite a wide search, only a limited number of studies met inclusion criteria, indicating weak evidence for the use of non-invasive biomarkers to guide treatment specifically for chronic cough in asthmatic patients. Nevertheless, inhaled corticosteroids emerged as the preferred initial treatment for cough due to both asthma and NAEB, potentially followed by leukotriene receptor antagonists if the response is insufficient.<br /><br />In summarizing the recommendations: <br />1. Non-invasive measurement of airway inflammation might have some utility, particularly in predicting responses to corticosteroids in asthma-related cough.<br />2. For cough variant asthma, inhaled corticosteroids should be the first-line treatment, with possible dose escalation or addition of leukotriene inhibitors if necessary.<br />3. In NAEB patients, inhaled corticosteroids are advised first, with dose escalation or leukotriene inhibitors considered if needed.<br /><br />The guideline identifies significant gaps in existing knowledge, emphasizing the need for more specific research on chronic cough in asthma and NAEB to better inform clinical practice. Current evidence largely draws from broader studies on asthma, highlighting the need for targeted investigation specifically addressing cough as a primary symptom.

Keywords

chronic cough

asthma

non-asthmatic eosinophilic bronchitis

NAEB

inhaled corticosteroids

leukotriene receptor antagonists

airway inflammation

biomarkers

randomized controlled trials

guideline recommendations