Cough in Children and Adults: Diagnosis, Assessment and Management (CICADA). Summary of an updated position statement on chronic cough in Australia

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Marchant, Julie M
Chang, Anne B
Kennedy, Emma
King, David
Perret, Jennifer L
Schultz, Andre
Toombs, Maree R
Versteegh, Lesley
Dharmage, Shyamali C
Dingle, Rebecca
Fitzerlakey, Naomi
George, Johnson
Holland, Anne
Rigby, Debbie
Mann, Jennifer
et al.
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2024
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Abstract

Introduction Cough is the most common symptom leading to medical consultation. Chronic cough results in significant health care costs, impairs quality of life, and may indicate the presence of a serious underlying condition. Here, we present a summary of an updated position statement on cough management in the clinical consultation.

Main recommendations Assessment of children and adults requires a focused history of chronic cough to identify any red flag cough pointers that may indicate an underlying disease. Further assessment with examination should include a chest x-ray and spirometry (when age > 6 years). Separate paediatric and adult diagnostic management algorithms should be followed. Management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns. First Nations adults and children should be considered a high risk group. The full statement from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia for managing chronic cough is available at https://lungfoundation.com.au/resources/cicada-full-position-statement.

Changes in management as a result of this statement Algorithms for assessment and diagnosis of adult and paediatric chronic cough are recommended. High quality evidence supports the use of child-specific chronic cough management algorithms to improve clinical outcomes, but none exist in adults. Red flags that indicate serious underlying conditions requiring investigation or referral should be identified. Early and effective treatment of chronic wet/productive cough in children is critical. Culturally specific strategies for facilitating the management of chronic cough in First Nations populations should be adopted. If the chronic cough does not resolve or is unexplained, the patient should be referred to a respiratory specialist or cough clinic.

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Medical Journal of Australia

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220

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1

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© 2023 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Biomedical and clinical sciences

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Life Sciences & Biomedicine

Medicine, General & Internal

General & Internal Medicine

Evidence-based medicine

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Marchant, JM; Chang, AB; Kennedy, E; King, D; Perret, JL; Schultz, A; Toombs, MR; Versteegh, L; Dharmage, SC; Dingle, R; Fitzerlakey, N; George, J; Holland, A; Rigby, D; Mann, J; 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, 220 (1), pp. 35-45