Managing Chronic Cough Due to Asthma and NAEB in Adults and Adolescents: CHEST Expert Panel Report

CHEST Expert Cough Panel

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


Background: Asthma and non-asthmatic eosinophilic bronchitis (NAEB) are among the commonest causes of chronic cough in adults. We sought to determine the role of non-invasive measurements of airway inflammation, including induced sputum and fractional exhaled nitric oxide, in the evaluation of cough associated with asthma, and what the best treatment is for cough due to asthma or NAEB. 

Methods: We undertook three systematic reviews of randomized controlled trials and observational trials of adults and adolescents > 12 years of age with a chronic cough due to asthma or NAEB. Eligible studies were identified in MEDLINE, CENTRAL, and SCOPUS and assessed for relevance and quality. Guidelines were developed and voted upon using CHEST guideline methodology. 

Results: Of the citations reviewed, 3/1,175, 53/656, and 6/134 were identified as being eligible for inclusion in the three systematic reviews, respectively. In contrast to established guidelines for asthma therapies in general and the inclusion in some guidelines for a role of biomarkers of airway inflammation to guide treatment in severe disease, the evidence of specific benefit related to the use of non-invasive biomarkers in patients with chronic cough due to asthma was weak. The best therapeutic option for cough in asthma or NAEB is inhaled corticosteroids followed by leukotriene receptor antagonism. 

Conclusions: This guideline offers recommendations on the role of non-invasive measurements of airway inflammation and treatment for cough due to asthma or NAEB based on the available literature, and identifies gaps in knowledge and areas for future research.

Original languageEnglish
Pages (from-to)68-96
Number of pages29
Issue number1
Early online date20 Jan 2020
Publication statusPublished - 01 Jul 2020

Bibliographical note

Funding Information:
Author contributions: All authors contributed to the design and analysis of the study and the writing of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: L.-P. B. discloses research grants provided to his institution from AstraZeneca, Boehringer Ingelheim, Boston Scientific, GlaxoSmithKline, Merck, Novartis, and Sanofi; consulting and advisory boards AstraZeneca, GSK, and Novartis. P. G. G. discloses institutional grants and speaker fees from AstraZeneca, GlaxoSmithKline, and Novartis. K. L. discloses grants and speaker fees from AstraZeneca, GlaxoSmithKline, Merck, Daiichi Sankyo, and Novartis. Although R. S. I. was the Editor in Chief of CHEST, the review and all editorial decisions regarding the manuscript were independently made by others. C. E. B. discloses grants and consultancy fees from AstraZeneca, MedImmune, Chiesi, GlaxoSmithKline, Novartis, Sanofi, Regeneron, Teva, Mologics, 4DPharma, Roche/Genentech, and Gossamer paid to his institution. None declared (A. C. R. J. R.). Role of sponsors: The CHEST organization was the sole supporter of these guidelines, this article, and the innovations addressed within. ?CHEST Expert Cough Panel Collaborators: 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), Fiona Blackhall, MD, PhD (University of Manchester, Department of Medical Oncology, Manchester, England), Donald C. Bolser, PhD (College of Veterinary Medicine, University of Florida, Gainesville, FL), Surinder S. Birring, MBChB, MD (Division of Asthma, Allergy and Lung Biology, King's College London, Denmark Hill, London, United Kingdom), Sidney S. Braman, MD, FCCP (Mount Sinai Hospital, New York, NY), Christopher Brightling, MBBS, PhD, FCCP (University of Leicester, Glenfield Hospital, Leicester, United Kingdom), Priscilla Callahan-Lyon, MD (Adamstown, 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, MSc, 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 Auckland, Auckland, New Zealand), Peter Gibson, MBBS (Hunter Medical Research Institute, New South Wales, Australia), 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), 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), 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), Craig Lilly, MD, FCCP (UMass Memorial Medical Center, Worcester, MA), Mark Lown, MB BS, PhD (University of Southampton, Aldermoor Health Centre, Aldermorr Close, Southampton, UK), 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, Abigail Moore, BM BCh (University of Oxford, Oxford, England), M. Hassan Murad, MD, MPH (Mayo Clinic, Rochester, MN), Mangala Narasimhan, DO, FCCP (Hofstra-Northwell Health, Manhasset, NY), John Oppenheimer, MD (UMDNJ-Rutgers University, Newark, NJ), Mark Rosen, MD, Master FCCP (Icahn School of Medicine at Mount Sinai, New York, NY), Bruce Rubin, MEngr, MD, MBA (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), Maeve P. Smith, MB ChB, MD (University of Alberta, Edmonton, AB, Canada), Susan M. Tarlo, MBBS, FCCP (Toronto Western Hospital, Toronto, ON, Canada), Anne E. Vertigan, PhD, MBA, BAppSc (SpPath) (John Hunter Hospital, New South Wales, Australia), and Miles Weinberger, MD, FCCP (University of Iowa Hospitals and Clinics, Iowa City, IA). Endorsements: This guideline has been endorsed by the American Association for Respiratory Care (AARC). Other contributions: The authors are indebted to and thank Nancy Harger, MLS, and Judy Nordberg, MLS, Education and Clinical Services Librarians in the University of Massachusetts Medical School Library who performed all of the systematic searches for each patient, intervention, comparison, and outcome question. Additional information: CHEST Expert Panel Collaborator, Mark Rosen, MD, FCCP, died July 2, 2019. The e-Appendixes and e-Figures can be found in the Supplemental Materials section of the online article.

Publisher Copyright:
© 2020 American College of Chest Physicians


  • asthma
  • bronchitis
  • cough

ASJC Scopus subject areas

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


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