CHEST Guidelines-Treatment of Interstitial Lung Disease Associated Cough

Treatment of Interstitial Lung Disease Associated Cough

Pdf Summary

The CHEST Guideline and Expert Panel Report addresses the treatment of chronic cough associated with Interstitial Lung Disease (ILD), which significantly impacts patients' quality of life. A systematic review evaluated the effectiveness of various therapies for this condition, focusing on adult patients with a chronic cough lasting at least eight weeks. Eight randomized controlled trials and two case series involving idiopathic pulmonary fibrosis (IPF), sarcoidosis, and scleroderma-associated ILD were included in the analysis.<br /><br />The review found that inhaled corticosteroids are not effective for cough associated with sarcoidosis or scleroderma-associated ILD. Furthermore, thalidomide was not recommended for treating IPF because it failed to gain enough support from the expert panel due to practical barriers and limited evidence. Instead, for refractory cough in ILD, the panel suggests following CHEST's unexplained chronic cough guidelines, considering approaches like neuromodulators (e.g., gabapentin) and speech pathology management. Opiates may be considered for symptom control in a palliative care setting, though their use should be carefully assessed.<br /><br />The guidelines stress the need for individualized management of ILD-related cough, given its potential connection to underlying ILD progression, immunosuppressive treatments, or co-morbid conditions like GERD and upper airway diseases. The recommendations highlight that current evidence for managing this subtype of chronic cough is limited and call for more research to establish effective treatment protocols. Future research should aim to better understand cough as a potential biomarker in ILD, utilize validated cough outcome measures, and explore the efficacy of novel antitussive therapies.

Keywords

chronic cough

Interstitial Lung Disease

quality of life

systematic review

idiopathic pulmonary fibrosis

sarcoidosis

scleroderma-associated ILD

neuromodulators

individualized management

antitussive therapies