TY - JOUR T1 - ERS guidelines on the diagnosis and treatment of chronic cough in adults and children JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01136-2019 SP - 1901136 AU - Alyn H. Morice AU - Eva Millqvist AU - Kristina Bieksiene AU - Surinder S. Birring AU - Peter Dicpinigaitis AU - Christian Domingo Ribas AU - Michele Hilton Boon AU - Ahmad Kantar AU - Kefang Lai AU - Lorcan McGarvey AU - David Rigau AU - Imran Satia AU - Jacky Smith AU - Woo-Jung Song AU - Thomy Tonia AU - Jan W. K. van den Berg AU - Mirjam J. G. van Manen AU - Angela Zacharasiewicz Y1 - 2019/01/01 UR - http://erj.ersjournals.com/content/early/2019/09/02/13993003.01136-2019.abstract N2 - These guidelines incorporate the recent advances in chronic cough pathophysiology, diagnosis and treatment. The concept of cough hypersensitivity has allowed an umbrella term that explains the exquisite sensitivity of patients to external stimuli such a cold air, perfumes, smoke and bleach. Thus adults with chronic cough now have a firm physical explanation for their symptoms based on vagal afferent hypersensitivity. Different treatable traits exist with cough variant asthma/eosinophilic bronchitis responding to anti inflammatory treatment and non acid reflux being treated with promotility agents rather the anti acid drugs. An alternative antitussive strategy is to reduce hypersensitivity by neuromodulation. Low dose morphine is highly effective in a subset of patients with cough resistant to other treatments. Gabapentin and pregabalin are also advocated but in clinical experience they are limited by adverse events. Perhaps the most promising future developments in pharmacotherapy are drugs which tackle neuronal hypersensitivity by blocking excitability of afferent nerves by inhibiting targets such as the ATP receptor (P2X3). Finally cough suppression therapy when performed by competent practitioners can be highly effective. Children are not small adults and a pursuit of an underlying cause for cough is advocated. Thus in toddlers inhalation of a foreign body is common. Persistent bacterial bronchitis is a common and previously unrecognised cause of wet cough in children. Antibiotics, (which, dose, and duration need to be determined) can be curative. Paediatric specific algorithm should be used.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Millqvist reports filed an international patent application (PCT application) for the use of capsaicin as a cough reducing product on January 3, 2014. There is a pending patent application in US, Canada and EU. In Australia a patent was issued on August 17 2017. However this treatment method is not described, recommended or emphasised in any way in the guidelines.Conflict of interest: Dr. Bieksiene has nothing to disclose.Conflict of interest: Dr. Birring reports grants from Merck, personal fees from Merck, personal fees from Bayer, personal fees from GSK, personal fees from Menlo, personal fees from Sanofi, other from Boehringer Ingleheim, outside the submitted work.Conflict of interest: Dr. Dicpinigaitis has nothing to disclose.Conflict of interest: Dr. Kantar Advisor for study design of an unlicensed product (Merck Sharp & Dohme, USA) Advisor for study design of an OCT product (Sanofi, Germany) and (Infirst, UK). No financial or intellectual conflicts of interest regarding the content of this manuscript.Conflict of interest: Dr. Lai reports grants and personal fees from AstraZeneca, grants and personal fees from GlaxoSmithKline, grants and personal fees from Merck, grants and personal fees from Daiyichi Sankyo, grants and personal fees from Novartis, outside the submitted work.Conflict of interest: Dr. McGarvey reports personal fees from Merck & Co., Inc., , grants, personal fees and non-financial support from Chiesi, personal fees and non-financial support from Boehringer Ingelheim, grants and non-financial support from Glaxo Smith Kline, grants and personal fees from Almirall, personal fees from Astra Zeneca, grants from NC3R, during the conduct of the study; grants from European Union Interreg VA Health & Life Science Programme, outside the submitted work.Conflict of interest: Dr. Rigau reports and declares he works as methodologist of the ERS.Conflict of interest: Dr. Satia is currently supported by ERS Marie Curie Respire 3 Global Fellowship program (713406), and reports grants from BMA James Trust Award, grants from North West Lung Centre Charity Grant, personal fees from Educational Talks for GPs, Travel Awards for attending conferences, outside the submitted work.Conflict of interest: Dr. Smith reports grants and personal fees from Glaxosmithkline, grants and personal fees from NeRRe Pharmaceuticals, grants and personal fees from Menlo, grants and personal fees from Bayer, personal fees from Boehringer Ingleheim, personal fees from Genentech, personal fees from Neomed, non-financial support from Vitalograph, personal fees from Cheisi, grants and personal fees from Afferent, personal fees from Bellus, grants and personal fees from Axalbion, grants and personal fees from Merck, personal fees and non-financial support from AstraZeneca, outside the submitted work; In addition, Dr. Smith has a patent A method for generating output data licensed.Conflict of interest: Dr. Song has nothing to disclose.Conflict of interest: Dr. Tonia acts as ERS methodologist.Conflict of interest: Dr. van den Berg reports personal fees from MSD, grants from Bayer, outside the submitted work.Conflict of interest: Dr. van Manen has nothing to disclose.Conflict of interest: Dr. Zacharasiewicz, I declare no conflicts of interest: I have received payment for consultant work for Vertex, Novartis, Abbvie, Loewenstein and travel sponsor from Mylan, Chiesi and Teva and suppport for Research from Abbvie.Conflict of interest: Dr. Morice reports grants, personal fees, non-financial support and other from Merck Sharp & Dohme Corp, grants, personal fees, non-financial support and other from Bayer AG Research & Development, grants, personal fees, non-financial support and other from Bayer US, personal fees, non-financial support and other from Bellus Health, personal fees and non-financial support from AstraZeneca, grants, personal fees, non-financial support and other from Sanofi, personal fees and non-financial support from Chiesi Ltd, grants, personal fees and non-financial support from GlaxoSmithKline, personal fees and non-financial support from Boehringer Ingelheim, grants, personal fees and other from NeRRe Therapeutics, grants, personal fees and non-financial support from Respivant Sciences, Inc., grants, personal fees, non-financial support and other from Phillips Respironics, grants from Menlo Therapeutics, during the conduct of the study.Conflict of interest: Dr. DOMINGO reports personal fees and other from MSD, personal fees, non-financial support and other from Novartis, personal fees, non-financial support and other from TEva, personal fees and other from Astra-Zeneca, personal fees from Allegy terapeutics, personal fees from Chiesi, from ALK, personal fees and other from Sanofi-Aventis, personal fees from Immunotek, personal fees from ESteve, personal fees from Ferrer, non-financial support from GSK, personal fees from Menarini, outside the submitted work.Conflict of interest: Dr. Hilton Boon reports grants from Medical Research Council (UK) (MC_UU_12017/15), and from Scottish Government Chief Scientist Office (SPHSU15), during the conduct of the study. 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