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1.1 Background Patients with cough frequently present to clinicians working in both primary and secondary care., Acute cough, which often follows an upper respiratory tract infection, may be initially disruptive but is usually self‐limiting and rarely needs significant medical intervention. Chronic cough is often the key symptom of many important chronic respiratory diseases but may be the sole presenting feature of a number of extrapulmonary conditions, in particular upper airway and gastrointestinal disease. Even with a clear diagnosis, cough can be difficult to control and, for the patient, can be associated with impaired quality of life., Sessions dedicated to cough at respiratory meetings are popular, suggesting that the pathophysiology, evaluation, and successful treatment of cough remain topics of keen interest to many medical practitioners. 1.2 Need and purpose of BTS recommendations on the management of cough The American College of Chest Physicians (ACCP) and the European Respiratory Society (ERS), have each endorsed their own set of guidelines on the management of cough; however, criticism of their content and breadth suggest the need for further concise recommendations.

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The British Thoracic Society guidelines cover not only chronic cough but also acute cough and the organisational issues of cough clinics. International differences in delivery of respiratory health care and management strategies support the notion that such guidelines would be desirable. The British Thoracic Society Standards of Care Committee agreed to the development of a Working Group tasked with the job of producing a set of guidelines for the management of cough with the following key objectives: •. 1.3 Structure of the guidelines The guidelines are prefaced with the key points and recommendations summarised as a table of abstracted bullet points.

The subsequent section begins with concise definitions for the key terms: cough, acute cough and chronic cough. Individual sections detailing guidelines for the management of acute and chronic cough with additional recommendations for specialist cough clinics follow. Each of these sections includes separate recommendations for management of cough in adults.

The final section contains appendices which include a recommended cough management algorithm for adults (available online only at ), together with a patient information sheet designed for primary care. 1.4 Methodology for generation of the guidelines The members of the guideline group initially met to discuss content, format and purpose of the document and to consider the most appropriate methodology for the critical review of available literature and the generation of recommendations. Consensus was obtained on these points and members of the Guideline Group were allocated to one of three subgroups concerned with acute cough, chronic cough, or specialist cough clinics.

These three clinical areas were further divided into sections and individuals were identified to conduct an independent literature search for each of these and to produce a discussion document based on their literature appraisal. The search engines recommended were Medline (1966 onwards), EMBASE, and the Cochrane Library database. These were applied to locate all English language studies relevant to the aetiology, diagnosis, severity staging, investigation, prognosis, complications, or treatment of chronic cough in adults over 16 years. At a subsequent meeting of the Guideline Group these documents were presented, discussed, and recommendations agreed upon. The existing lack of evidence made the formulation of evidence based guidelines difficult. A striking example of this is that a search of the Cochrane Library database to 2005 for systematic reviews of treatment of cough in adults generated one article. Consequently, recommendations have been made based on the available reliability of evidence and, where indicated, on the clinical experience of the members of the Guideline Group.

Because of the generally poor level of evidence and the consequent arbitrary nature of the recommendations, a grading system was thought to be inappropriate. Download sim201 ssl84b. Once the individual sections were complete, an initial document was drafted which was then circulated to the BTS Standards of Care Committee. Chronic cough is defined as one lasting more than 8 weeks. Classification of cough based on symptom duration is somewhat arbitrary.