Chronic Cough Due to Stable Chronic Bronchitis CHEST Expert Panel Report Mark A. Malesker, PharmD, FCCP; Priscilla Callahan-Lyon, MD; J. Mark Madison, MD, FCCP; Belinda Ireland, MD; and Richard S. Irwin, MD, Master FCCP; on behalf of the CHEST Expert Cough Panel * Endorsed by the American Association for Respiratory Care BACKGROUND: Chronic cough due to chronic bronchitis (CB) causes significant impairment in quality of life, and effective treatment strategies are needed. We conducted a systematic review on the management of chronic cough due to CB to update the recommendations and suggestions of the American College of Chest Physicians (CHEST) 2006 guideline on this topic. METHODS: This systematic review asked three questions: (1) What are the clinical features of the history that suggest a patient’s cough-phlegm syndrome is due to CB? (2) Can treatment of stable CB improve or eliminate chronic cough? (3) Can therapy that targets chronic cough due to CB prevent or reduce the occurrence of acute CB exacerbations? Studies of adult patients with CB were included and assessed for relevance and quality. Based on the sys- tematic review, guideline suggestions were developed and voted on by using the CHEST organization methodology. RESULTS: The search strategy used an assortment of descriptors and assessments to identify studies of chronic cough due to CB. CONCLUSIONS: The evidence supporting the management of chronic cough due to CB is limited overall and of low quality. This article provides guidance on treatment by presenting suggestions based on the best currently available evidence and identifies gaps in our knowledge and areas for future research. CHEST 2020; 158(2):705-718 KEY WORDS: chronic bronchitis; chronic cough; nonpharmacological treatment; pharmacological treatment ABBREVIATIONS: CB = chronic bronchitis; CHEST = American Col- lege of Chest Physicians; GOC = Guidelines Oversight Committee; GRADE = Grading of Recommendations Assessment, Development and Evaluation; KQ = key question; PICO = population, intervention, comparator, and outcome AFFILIATIONS: From the Pharmacy Practice Department (Dr Mal- esker), Creighton University, Omaha, NE; Adamstown, MD (Dr Callahan-Lyon); Division of Pulmonary, Allergy, and Critical Care Medicine (Drs Madison and Irwin), University of Massachusetts Medical School, Worcester, MA; and TheEvidenceDoc (Dr Ireland), Pacific, MO. *Collaborators from the CHEST Expert Cough Panel are listed in the Acknowledgments. 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 al- ways 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. FUNDING/SUPPORT: CHEST was the sole supporter of these guide- lines, this article, and the innovation addressed within. CORRESPONDENCE TO: Mark A. Malesker, PharmD, FCCP, Pharmacy Practice Department, Creighton University, 2500 California Plaza, Omaha, NE 68178; e-mail: [email protected] Copyright Ó 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. DOI: https://doi.org/10.1016/j.chest.2020.02.015 [ Education and Clinical Practice Guidelines and Consensus Statements ] chestjournal.org 705
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