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WAO-ARIA consensus on chronic cough - Part III: Management strategies in primary and cough-specialty care. Updates in COVID-19.
Rouadi, Philip W; Idriss, Samar A; Bousquet, Jean; Laidlaw, Tanya M; Azar, Cecilio R; Al-Ahmad, Mona S; Yañez, Anahi; Al-Nesf, Maryam Ali Y; Nsouli, Talal M; Bahna, Sami L; Abou-Jaoude, Eliane; Zaitoun, Fares H; Hadi, Usamah M; Hellings, Peter W; Scadding, Glenis K; Smith, Peter K; Morais-Almeida, Mario; Maximiliano Gómez, René; Gonzalez Diaz, Sandra N; Klimek, Ludger; Juvelekian, Georges S; Riachy, Moussa A; Canonica, Giorgio Walter; Peden, David; Wong, Gary W K; Sublett, James; Bernstein, Jonathan A; Wang, Lianglu; Tanno, Luciana K; Chikhladze, Manana; Levin, Michael; Chang, Yoon-Seok; Martin, Bryan L; Caraballo, Luis; Custovic, Adnan; Ortego-Martell, Jose Antonio; Lesslar, Olivia J Ly; Jensen-Jarolim, Erika; Ebisawa, Motohiro; Fiocchi, Alessandro; Ansotegui, Ignacio J.
  • Rouadi PW; Department of Otolaryngology - Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon.
  • Idriss SA; Ear, Nose and Throat Department, Dar Al Shifa Hospital, Hawally, Kuwait.
  • Bousquet J; Department of Otolaryngology - Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon.
  • Laidlaw TM; Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Lyon, France.
  • Azar CR; Hospital Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
  • Al-Ahmad MS; Department of Dermatology and Allergy, Comprehensive Allergy Center, Berlin Institute of Health, Berlin, Germany.
  • Yañez A; Macvia France, Montpellier France.
  • Al-Nesf MAY; Université Montpellier, Montpellier, France.
  • Nsouli TM; Department of Medicine, Harvard Medical School, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital Boston, Massachusetts, USA.
  • Bahna SL; Department of Gastroenterology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon.
  • Abou-Jaoude E; Department of Gastroenterology, Middle East Institute of Health (MEIH), Beirut, Lebanon.
  • Zaitoun FH; Department of Gastroenterology, Clemenceau Medical Center (CMC), Beirut, Lebanon.
  • Hadi UM; Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.
  • Hellings PW; INAER - Investigaciones en Alergia y Enfermedades Respiratorias, Buenos Aires, Argentina.
  • Scadding GK; Allergy and Immunology Section, Department of Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar.
  • Smith PK; International Cough Institute, Washington, DC, USA.
  • Morais-Almeida M; Allergy & Immunology Section, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
  • Maximiliano Gómez R; International Cough Institute, Washington, DC, USA.
  • Gonzalez Diaz SN; Department of Allergy Otolaryngology, LAU-RIZK Medical Center, Beirut, Lebanon.
  • Klimek L; Clinical Professor Department of Otolaryngology Head and Neck Surgery, American University of Beirut, Lebanon.
  • Juvelekian GS; KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology, Leuven, Belgium.
  • Riachy MA; University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium.
  • Canonica GW; University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium.
  • Peden D; Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, the Netherlands.
  • Wong GWK; Department of ENT, RNENT Hospital, London, UK.
  • Sublett J; Clinical Medicine Griffith University, Southport Qld, 4215, Australia.
  • Bernstein JA; Allergy Center, CUF Descobertas Hospital, Lisboa, Portugal.
  • Wang L; School of Health Sciences, Catholic University of Salta, Argentina.
  • Tanno LK; Universidad Autónoma de Nuevo León, Hospital Universitario and Facultad de Medicina, Monterrey, Nuevo León, Mexico.
  • Chikhladze M; Center for Rhinology and Allergology, Wiesbaden, Germany.
  • Levin M; Department of Pulmonary, Critical Care and Sleep Medicine at Saint George Hospital University Medical Center, Beirut, Lebanon.
  • Chang YS; Department of Pulmonary and Critical Care, Hôtel-Dieu de France university Hospital, Beirut, Lebanon.
  • Martin BL; Humanitas University & Personalized Medicine Asthma & Allergy Clinic-Humanitas Research Hospital-IRCCS-Milano Italy.
  • Caraballo L; UNC Center for Environmental Medicine, Asthma, and Lung Biology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics UNC School of Medicine, USA.
  • Custovic A; Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China.
  • Ortego-Martell JA; Department of Pediatrics, Section of Allergy and Immunology, University of Louisville School of Medicine, 9800 Shelbyville Rd, Louisville, KY, USA.
  • Lesslar OJL; University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, OH, USA.
  • Jensen-Jarolim E; Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, State Key Laboratory of Complex Severe and Rare Diseases, National Clini
  • Ebisawa M; Université Montpellier, Montpellier, France.
  • Fiocchi A; Desbrest Institute of Epidemiology and Public Health, UMR UA-11, INSERM University of Montpellier, Montpellier, France.
  • Ansotegui IJ; WHO Collaborating Centre on Scientific Classification Support, Montpellier, France.
World Allergy Organ J ; 15(5): 100649, 2022 May.
Article in English | MEDLINE | ID: covidwho-1860142
ABSTRACT

Background:

Chronic cough management necessitates a clear integrated care pathway approach. Primary care physicians initially encounter the majority of chronic cough patients, yet their role in proper management can prove challenging due to limited access to advanced diagnostic testing. A multidisciplinary approach involving otolaryngologists and chest physicians, allergists, and gastroenterologists, among others, is central to the optimal diagnosis and treatment of conditions which underly or worsen cough. These include infectious and inflammatory, upper and lower airway pathologies, or gastro-esophageal reflux. Despite the wide armamentarium of ancillary testing conducted in cough multidisciplinary care, such management can improve cough but seldom resolves it completely. This can be due partly to the limited data on the role of tests (eg, spirometry, exhaled nitric oxide), as well as classical pharmacotherapy conducted in multidisciplinary specialties for chronic cough. Other important factors include presence of multiple concomitant cough trigger mechanisms and the central neuronal complexity of chronic cough. Subsequent management conducted by cough specialists aims at control of cough refractory to prior interventions and includes cough-specific behavioral counseling and pharmacotherapy with neuromodulators, among others. Preliminary data on the role of neuromodulators in a proof-of-concept manner are encouraging but lack strong evidence on efficacy and safety.

Objectives:

The World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough reviewed the recent literature on management of chronic cough in primary, multidisciplinary, and cough-specialty care. Knowledge gaps in diagnostic testing, classical and neuromodulator pharmacotherapy, in addition to behavioral therapy of chronic cough were also analyzed.

Outcomes:

This third part of the WAO/ARIA consensus on chronic cough suggests a management algorithm of chronic cough in an integrated care pathway approach. Insights into the inherent limitations of multidisciplinary cough diagnostic testing, efficacy and safety of currently available antitussive pharmacotherapy, or the recently recognized behavioral therapy, can significantly improve the standards of care in patients with chronic cough.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Diagnostic study Language: English Journal: World Allergy Organ J Year: 2022 Document Type: Article Affiliation country: J.waojou.2022.100649

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Diagnostic study Language: English Journal: World Allergy Organ J Year: 2022 Document Type: Article Affiliation country: J.waojou.2022.100649