An Empiric Integrative Approach to the Management of Cough : ACCP Evidence-Based Clinical Practice Guidelines

Objective:Review the literature to provide a comprehensive approach, including algorithms for the clinician to follow in evaluating and treating the patient with acute, subacute, and chronic cough.Methods:We searched MEDLINE (through May 2004) for studies published in the English language since 1980 on human subjects using the medical subject heading terms “cough,” “treatment of cough,” and “empiric treatment of cough.” We selected case series and prospective descriptive clinical trials. We also obtained any references from these studies that were pertinent to the topic.Results:The relative frequency of the disorders (alone and in combination) that can cause cough as well as the sensitivity and specificity of many but not all diagnostic tests in predicting the cause of cough are known. An effective approach to successfully manage chronic cough is to sequentially evaluate and treat for the common causes of cough using a combination of selected diagnostic tests and empiric therapy. Sequential and additive therapy is often crucial because more than one cause of cough is frequently present.Conclusion:Algorithms that provide a “road map” that the clinician can follow are useful and are presented for acute, subacute, and chronic cough.