Acute cough is costing the UK economy an estimated £979 million a year. Chronic cough is also a significant problem and further research into the treatment for chronic cough is needed, according to new guidelines released today by the British Thoracic Society (BTS).
The guidelines, published in Thorax, the international journal of respiratory medicine, are the first in the UK to provide evidence-based recommendations for the management of cough in adults. They draw a clear distinction between acute cough and chronic cough, and the need to manage the two categories differently.
Chronic cough is defined as:
- Lasting for more than 8 weeks
- Reported by 10-20% of adults
- Most common in middle-aged women and obese people
- Causing similar detriment in quality of life to COPD
Chronic coughs can impair quality of life and impact on home and social life, causing considerable distress to sufferers and their families. Most types of chronic cough are indicative of an aggravant such as: asthma, drugs, environmental exposures, gastro-oesophageal reflux ('heartburn'), upper airway disease. However, around 25% of chronic cough cases cannot be attributed to a specific cause. The BTS guidelines indicate a need for further research into "undiagnosed" chronic cough, and recommend that patients are assessed at a specialist cough clinic before the cough is classified as 'undiagnosed' or 'idiopathic'.
In treating chronic cough, the guidelines indicate that there is not one single diagnostic protocol to be recommended, but that a combination of selected diagnostic testing and empirical trials of treatment is likely to be most cost effective. At present, the use of "ambulatory cough recording", 24 hour monitoring of cough in a realistic setting, seems to offer the best prospect for objective measurement of cough.
Professor Ian Pavord, co-chair of the British Thoracic Society cough guidelines group said,
"Chronic cough is a common condition which is currently under-researched. While an attempt is being made to understand the condition and create better diagnostic protocols and treatments, there are still a significant number of patients who we can't help with specific treatment.
"It is important for healthcare professionals to use objective measures of cough severity when evaluating the effects of drugs and other treatments for chronic cough. New diagnostic tools are being produced all the time, but there is still some way to go.
"The use of ambulatory cough recording is an area of active research which is proving to be particularly useful in assessing the severity of cough. There are currently few centres offering this diagnostic method but hopefully in time it will be more widely available.
"There is also a need for more clinical trials on new drugs to be carried out across specialist centres, using objective measures such as cough counting, as well as subjective evaluations of quality of life and symptoms."
For further information, copies of the guidelines and to set up interviews with lung specialists, please contact Anna Gardner or Emily Shelton on 020 7815 3900 or email firstname.lastname@example.org
 This estimated cost compromises £875 million due to loss of productivity, and £104 million in healthcare system costs and the purchase of non-prescription medicines
 BTS guidelines: recommendations for the management of cough in adults, published in Thorax, September 2006, vol. 61, supplement 1 by BMJ publishing group