CHEST Guidelines-Treatment-of-Interstitial-Lung-Disease-Associated-

Treatment-of-Interstitial-Lung-Disease-Associated-

Pdf Summary

The CHEST Guideline and Expert Panel Report addresses the treatment of chronic cough associated with interstitial lung disease (ILD), a condition significantly impacting patients' quality of life. The systematic review highlighted a limited number of studies examining various treatments for this kind of cough, including idiopathic pulmonary fibrosis (IPF), sarcoidosis, and scleroderma-related ILD. Key findings and recommendations from the report include:

1. <strong>Assessment of Cough</strong>: Patients with ILD and troublesome cough should be evaluated for disease progression and treatment complications. Extra attention should be given to alternative potential causes like asthma, gastroesophageal reflux disease (GERD), and side effects of medications.

2. <strong>Proton Pump Inhibitors (PPIs)</strong>: These should not be routinely used for IPF patients with a chronic cough and negative GERD workup, due to a lack of evidence supporting their effectiveness in this context.

3. <strong>Inhaled Corticosteroids</strong>: These are not recommended for treating chronic cough associated with pulmonary sarcoidosis, as the studies revealed no significant benefit.

4. <strong>Therapies for Refractory Cough</strong>: In cases where cough is refractory, the panel suggests trying therapies for unexplained chronic cough, such as gabapentin and speech pathology therapy, following the CHEST unexplained chronic cough guidelines.

5. <strong>Use of Opiates</strong>: In instances where alternative treatments have failed, and cough significantly affects quality of life, the use of opiates can be considered for symptom control, especially in a palliative care setting. However, a reassessment of their benefits and risks should be made regularly.

Overall, the recommendations emphasize the need for individualized treatment plans and suggest that future research should focus on understanding the pathophysiology of cough in ILD better. This research would include exploring new treatment options like neuromodulators and inhaled therapies. Until more evidence is available, managing chronic cough associated with ILD should integrate available guidelines for chronic cough management.

Keywords

chronic cough

interstitial lung disease

idiopathic pulmonary fibrosis

sarcoidosis

scleroderma

proton pump inhibitors

inhaled corticosteroids

refractory cough therapies

opiate use

individualized treatment