Treatment of Interstitial Lung Disease Associated Cough: CHEST Guideline and Expert Panel Report

Chest. 2018 Oct;154(4):904-917. doi: 10.1016/j.chest.2018.06.038. Epub 2018 Jul 20.

Abstract

Background: Chronic cough in interstitial lung disease (ILD) causes significant impairment in quality of life. Effective treatment approaches are needed for cough associated with ILD.

Methods: This systematic review asked: Is there evidence of clinically relevant treatment effects for therapies for cough in ILD? Studies of adults aged > 18 years with a chronic cough ≥ 8 weeks' duration were included and assessed for relevance and quality. Based on the systematic review, guideline suggestions were developed and voted on by using CHEST guideline methodology.

Results: Eight randomized controlled trials and two case series (≥ 10 patients) were included that reported data on patients with idiopathic pulmonary fibrosis, sarcoidosis, and scleroderma-related ILD who received a variety of interventions. Study quality was high in all eight randomized controlled trials. Inhaled corticosteroids were not supported for cough associated with sarcoidosis. Cyclophosphamide and mycophenolate were not supported for solely treating cough associated with scleroderma-associated ILD. A recommendation for thalidomide to treat cough associated with idiopathic pulmonary fibrosis did not pass the panel vote. In view of the paucity of antitussive treatment options for refractory cough in ILD, the guideline panel suggested that the CHEST unexplained chronic cough guideline be followed by considering options such as the neuromodulator gabapentin and speech pathology management. Opiates were also suggested for patients with cough refractory to alternative therapies.

Conclusions: The evidence supporting the management of chronic cough in ILD is limited. This guideline presents suggestions for managing and treating cough on the best available evidence, but future research is clearly needed.

Keywords: chronic cough: interstitial lung disease; refractory; sarcoidosis; scleroderma; treatment; unexplained.

Publication types

  • Systematic Review

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Chronic Disease
  • Cough / etiology
  • Cough / therapy*
  • Humans
  • Lung Diseases, Interstitial / complications*
  • Middle Aged
  • Practice Guidelines as Topic
  • Randomized Controlled Trials as Topic
  • Sarcoidosis, Pulmonary / complications
  • Scleroderma, Systemic / complications
  • Young Adult

Substances

  • Adrenal Cortex Hormones