A newly updated Australian position statement on the diagnosis and management of chronic cough, Cough in Children and Adults: Diagnosis, Assessment, and Management (CICADA), has been released to standardize clinical approaches and highlight the significant burden of chronic cough, particularly within First Nations communities.
The guidelines offer recommendations for the initial assessment of chronic cough, including identifying key red flags in patient history and examination. Separate diagnostic algorithms have been developed for children and adults, recognizing that the underlying causes of chronic cough differ between the two groups. The guidelines emphasize the need for tailored management strategies based on the latest high-quality evidence.
The updated CICADA statement was developed by a multidisciplinary team of experts who conducted a comprehensive review of recent research. Of the 6,395 articles reviewed, 277 new studies published since 2010 were included in this update. The guidelines use the GRADE system to evaluate the effectiveness of treatment recommendations for chronic cough, ensuring evidence-based care
Overview of Cough as a Clinical Concern
Cough is the most common symptom leading to medical consultations. Chronic cough, in particular, results in significant healthcare costs, impairs quality of life, and may signal the presence of a serious underlying condition. This summary outlines key points from the updated position statement on chronic cough management during clinical consultations.
Main Recommendations
Assessment of Chronic Cough in Children and Adults
- A focused history of chronic cough is essential to identify any red flag symptoms, which may indicate an underlying disease.
- Further assessments should include:
- Chest X-ray
- Spirometry (for patients over 6 years old)
- Separate diagnostic and management algorithms for pediatric and adult chronic cough should be followed.
Management of Underlying Conditions
- Treatment should follow specific disease guidelines for the underlying condition.
- Address adverse environmental exposures that may exacerbate cough.
- Consider patient and caregiver concerns during management.
- First Nations adults and children are classified as a high-risk group and should receive tailored care.
Changes in Management as a Result of the Statement
- Algorithms for assessment and diagnosis of chronic cough are recommended for both adults and children.
- High-quality evidence supports the use of child-specific chronic cough management algorithms, leading to improved clinical outcomes, though such algorithms are currently lacking for adults.
- Red flags signaling serious underlying conditions should be identified early to prompt investigation or referral.
- Early and effective treatment of chronic wet/productive cough in children is critical.
- Culturally specific strategies should be adopted for managing chronic cough in First Nations populations.
- If the chronic cough is unresolved or unexplained, referral to a respiratory specialist or cough clinic is recommended.
To know more: https://doi.org/10.5694/mja2.52157
Reference: Marchant JM, et al. Cough in Children and Adults: Diagnosis, Assessment and Management (CICADA). Summary of an updated position statement on chronic cough in Australia. Medical Journal of Australia. 2024 Jan 15;220(1):35-45.