Life-Threatening and Non-Life-Threatening Complications Associated With Coughing: A Scoping Review

CHEST Expert Cough Panel

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Background: This is an update of the section on complications that are associated with coughing in the 2006 CHEST cough guidelines that addresses two aims: (1) to systematically identify and thematically categorize the diverse complications of cough by providing a guide for future studies and (2) to identify gaps in the literature for future research. 

Research Question: What are the potential complications that are associated with the act of coughing that have been reported in infants, children, adolescents, and adults? 

Study Design and Methods: A scoping review was performed with the use of PubMed and SCOPUS databases that were searched from their beginning until September 6, 2019. 

Results: Two hundred forty-seven publications met our inclusion criteria. To these, we added 38 articles from the 2006 complications paper that were not identified in the literature search plus the paper itself for a final total of 286 publications that formed the basis of this review. Since 2006, three new categories of complications have been reported: ear, nose and throat; disease transmission; and laboratory testing. Multiple additional complications that fall outside of these three categories have also been identified and included in the following categories: cardiovascular, constitutional symptoms, dermatologic, GI, genitourinary, musculoskeletal, neurologic, ophthalmologic, psychosocial/quality of life, and respiratory. Not previously highlighted is that some of the complications led to serious morbidity that included death, especially in patients with comorbid conditions, and potentially resulted in harm to others when cough resulted in a motor vehicle accident. 

Interpretation: Our work identified a large number of cough complications that we thematically categorized primarily by organ system so that future studies of each system or each complication can be conducted. The gap in the literature that future studies should address is to identify the frequency of the complications and the strength of their association with cough. Only then will one be able to describe the findings in a manner that allows specific recommendations for avoiding these complications. In the meantime, patients with cough should be evaluated and treated according to evidence-based guidelines to mitigate or prevent the myriad of potential complications that are associated with coughing.

Original languageEnglish
Pages (from-to)2058-2073
Number of pages16
Issue number5
Early online date18 Jun 2020
Publication statusPublished - 01 Nov 2020

Bibliographical note

Funding Information:
Author contributions: All authors had full access to all the data in the study; therefore, all take responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. R. S. I. sered as the principal author. C. L. F. and N. D. contributed substantially to the study design, data analysis, and interpretation, and the writing of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: R. S. I. and C. L. F. as co-developers of the Cough Quality of Life Questionnaire, report that they hold the copyright of this patient-reported outcome measure that is mentioned in this review. None declared (N. D.). ?CHEST Expert Cough Panel Collaborators: Abd Moain Abu Dabrh, MBBCh, MS (Mayo Clinic, Jacksonville, FL); Kenneth W. Altman, MD, PhD (Geisinger Commonwealth School of Medicine, Danville, PA); Elie Azoulay, MD, PhD (University of Paris, Paris, France); Alan F. Barker, MD (Oregon Health & Science University, Portland, OR); Surinder S. Birring, MBChB, MD (Division of Asthma, Allergy and Lung Biology, King's College London, Denmark Hill, London, United Kingdom); Donald C. Bolser, PhD, and Louis-Philippe Boulet, MD, FCCP (Institut universitaire de cardiologie et de pneumonlogie de Qu?bec, Quebec, [IUCPQ], QC, Canada); Sidney S. Braman, MD, FCCP (Mount Sinai Hospital, New York, NY); Christopher Brightling, MBBS, PhD, FCCP (University of Leicester, Glenfield Hospital, Leicester, United Kingdom); Brendan Canning, PhD (Johns Hopkins Asthma and Allergy Center, Baltimore, MD); Anne B. Chang, MBBS, PhD, MPH (Royal Children's Hospital, Queensland, Australia); Terrie Cowley (The TMJ Association, Milwaukee, WI); Paul Davenport, PhD (Department of Physiological Sciences, University of Florida, Gainesville, FL); Ali A. El Solh, MD, MPH (University at Buffalo, State University of New York, Buffalo, NY); Patricio Escalante, MD, FCCP (Mayo Clinic, Rochester, MN); Stephen K. Field, MD (University of Calgary, Calgary, AB, Canada); Dina Fisher, MD, MSc (University of Calgary, Respiratory Medicine, Calgary, AB, Canada); Cynthia T. French, PhD, FCCP (UMass Memorial Medical Center, Worcester, MA); Cameron Grant, MB ChB, PhD (University of Aukland, New Zealand); Susan M. Harding, MD, FCCP (Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL); Anthony Harnden, MB ChB, MSc (University of Oxford, Oxford, England); Adam T. Hill, MB ChB, MD (Royal Infirmary and University of Edinburgh, Edinburgh, Scotland); Richard S. Irwin, MD, Master FCCP (UMass Memorial Medical Center, Worcester, MA); Vivek Iyer, MD, MPH Mayo Clinic, Rochester MN); Peter J. Kahrilas, MD (Feinberg School of Medicine, Northwestern University, Chicago, IL); Joanne Kavanagh, MBChB (Division of Asthma, Allergy and Lung Biology, King's College London); Denmark Hill, London, United Kingdom); Karina A. Keogh, MD (Mayo Clinic, Rochester, MN); Kefang Lai, MD, PhD (First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China); Andrew P. Lane, MD (Johns Hopkins University School of Medicine, Baltimore, MD); Kaiser Lim, MD (Mayo Clinic, Rochester, MN); J. Mark Madison, MD, FCCP (UMass Memorial Medical Center, Worcester, MA); Mark A. Malesker, PharmD, FCCP (Creighton University School of Pharmacy and Health Professions, Omaha, NE); Stuart Mazzone, PhD, FCCP (University of Melbourne, Victoria, Australia); Lorcan McGarvey, MD (The Queens University Belfast, Belfast, United Kingdom); Alex Molasoitis, PhD, RN (Hong Kong Polytechnic University, Hong Kong, China); Abigail Moore, BM BCh (University of Oxford, Oxford, England); M. Hassan Murad, MD, MPH (Mayo Clinic, Rochester, MN); Peter Newcombe, PhD (School of Psychology University of Queensland, QLD, Australia); John Oppenheimer, MD (UMDNJ-Rutgers University); Bruce Rubin, MEngr, MD (Virginia Commonwealth University, Richmond, VA); Richard J. Russell, MBBS (University of Leicester, Glenfield Hospital, Leicester, United Kingdom); Jay H. Ryu, MD, FCCP (Mayo Clinic, Rochester, MN); Sonal Singh, MD, MPH (UMass Memorial Medical Center, Worcester, MA); Jaclyn Smith, MB ChB, PhD (University of Manchester, Manchester, England); Susan M. Tarlo, MBBS, FCCP (Toronto Western Hospital, Toronto, ON, Canada); Anne E. Vertigan, PhD, BAppSc (SpPath) (John Hunter Hospital, NSW, Australia). Other contributions: We thank Nancy Harger, MLS, clinical service librarian who works in the University of Massachusetts Medical School Library, Worcester, MA, who undertook all the searches for this systematic review. Additional information: The e-Appendix and e-Table can be found in the Supplemental Materials section of the online article. FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Publisher Copyright:
© 2020 American College of Chest Physicians


  • complication
  • cough
  • organ system

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine


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