Background
Asthma and non-asthmatic eosinophilic bronchitis (NAEB) are among the commonest causes
of chronic cough in adults. We sought to determine the role of non-invasive measurements
of airway inflammation, including induced sputum and fractional exhaled nitric oxide,
in the evaluation of cough associated with asthma, and what the best treatment is
for cough due to asthma or NAEB.
Methods
We undertook three systematic reviews of randomized controlled trials and observational
trials of adults and adolescents > 12 years of age with a chronic cough due to asthma
or NAEB. Eligible studies were identified in MEDLINE, CENTRAL, and SCOPUS and assessed
for relevance and quality. Guidelines were developed and voted upon using CHEST guideline
methodology.
Results
Of the citations reviewed, 3/1,175, 53/656, and 6/134 were identified as being eligible
for inclusion in the three systematic reviews, respectively. In contrast to established
guidelines for asthma therapies in general and the inclusion in some guidelines for
a role of biomarkers of airway inflammation to guide treatment in severe disease,
the evidence of specific benefit related to the use of non-invasive biomarkers in
patients with chronic cough due to asthma was weak. The best therapeutic option for
cough in asthma or NAEB is inhaled corticosteroids followed by leukotriene receptor
antagonism.
Conclusions
This guideline offers recommendations on the role of non-invasive measurements of
airway inflammation and treatment for cough due to asthma or NAEB based on the available
literature, and identifies gaps in knowledge and areas for future research.
Key Words
Abbreviations:
Feno ( fractional exhaled nitric oxide), NAEB ( non-asthmatic eosinophilic bronchitis), RCT ( randomized controlled trial)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: January 20, 2020
Footnotes
DISCLAIMER: American College of Chest Physician guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which always should be sought for any medical condition. The complete disclaimer for this guideline can be accessed at http://www.chestnet.org/Guidelines-and-Resources/Guidelines-and-Consensus-Statements/CHEST-Guidelines.
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© 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
