Global Physiology and Pathophysiology of Cough: Part 2. Demographic and Clinical Considerations: CHEST Expert Panel Report

CHEST Expert Cough Panel

doi:10.1016/j.chest.2021.04.039

Global Physiology and Pathophysiology of Cough: Part 2. Demographic and Clinical Considerations: CHEST Expert Panel Report

CHEST Expert Cough Panel

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Cough characteristics vary between patients, and this can impact clinical diagnosis and care. The purpose of part two of this state-of-the-art review is to update the American College of Chest Physicians (CHEST) 2006 guideline on global physiology and pathophysiology of cough. Study Design and Methods: A review of the literature was conducted using PubMed and MEDLINE databases from 1951 to 2019 using prespecified search terms. Results: We describe the demographics of typical patients with cough in the clinical setting, including how cough characteristics change across age. We summarize the effect of common clinical conditions impacting cough mechanics and the physical properties of mucus on airway clearance. Interpretation: This is the second of a two-part update to the 2006 CHEST cough guideline; it complements part one on basic phenomenology of cough by providing an extended clinical picture of cough along with the factors that alter cough mechanics and efficiency in patients. A greater understanding of the physiology and pathophysiology of cough will improve clinical management.

Original language	English (US)
Pages (from-to)	1413-1423
Number of pages	11
Journal	CHEST
Volume	160
Issue number	4
DOIs	https://doi.org/10.1016/j.chest.2021.04.039
State	Published - Oct 2021

Keywords

airway clearance
cough
demographics
mucus
pathophysiology
physiology

ASJC Scopus subject areas

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

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10.1016/j.chest.2021.04.039

Cite this

@article{8f309bde50434f58af215b4116620cf9,

title = "Global Physiology and Pathophysiology of Cough: Part 2. Demographic and Clinical Considerations: CHEST Expert Panel Report",

abstract = "Background: Cough characteristics vary between patients, and this can impact clinical diagnosis and care. The purpose of part two of this state-of-the-art review is to update the American College of Chest Physicians (CHEST) 2006 guideline on global physiology and pathophysiology of cough. Study Design and Methods: A review of the literature was conducted using PubMed and MEDLINE databases from 1951 to 2019 using prespecified search terms. Results: We describe the demographics of typical patients with cough in the clinical setting, including how cough characteristics change across age. We summarize the effect of common clinical conditions impacting cough mechanics and the physical properties of mucus on airway clearance. Interpretation: This is the second of a two-part update to the 2006 CHEST cough guideline; it complements part one on basic phenomenology of cough by providing an extended clinical picture of cough along with the factors that alter cough mechanics and efficiency in patients. A greater understanding of the physiology and pathophysiology of cough will improve clinical management.",

keywords = "airway clearance, cough, demographics, mucus, pathophysiology, physiology",

author = "{CHEST Expert Cough Panel} and Lorcan McGarvey and Rubin, {Bruce K.} and Satoru Ebihara and Karen Hegland and Alycia Rivet and Irwin, {Richard S.} and Bolser, {Donald C.} and Chang, {Anne B.} and Gibson, {Peter G.} and Mazzone, {Stuart B.} and Altman, {Kenneth W.} and Barker, {Alan F.} and Birring, {Surinder S.} and Fiona Blackhall and Braman, {Sidney S.} and Christopher Brightling and Andr{\'e}anne Cot{\'e} and {El Solh}, {Ali A.} and Patricio Escalante and Field, {Stephen K.} and Dina Fisher and French, {Cynthia T.} and Cameron Grant and Harding, {Susan M.} and Anthony Harnden and Hill, {Adam T.} and Kahrilas, {Peter J.} and Joanne Kavanagh and Keogh, {Karina A.} and Lane, {Andrew P.} and Madison, {J. Mark} and Malesker, {Mark A.} and Stuart Mazzone and Murad, {M. Hassan} and Mangala Narasimhan and Peter Newcombe and John Oppenheimer and Bruce Rubin and Russell, {Richard J.} and Ryu, {Jay H.} and Sonal Singh and Smith, {Maeve P.} and Tarlo, {Susan M.} and Vertigan, {Anne E.}",

note = "Funding Information: Financial/nonfinancial disclosures: The authors have reported to CHEST the following: S. B. M. declares personal fees from Merck and NeRRe Therapeutics and grant support from Merck , the Australian National Health and Medical Research Council , and the Australian Research Council . L. M. reports personal fees from Chiesi , GSK, Merck , NeRRe Therapeutics, and Shionogi Inc; grant support from Merck; and other support from AstraZeneca , Boehringer Ingelheim, and Chiesi . A. B. C. has received fees from Up to Date, is on the data safety monitoring board for a vaccine study (Glaxo), is an advisor for study design of an unlicensed product ( Merck ), and has received multiple peer reviewed competitive grants from the Australian National Health and Medical Research Council . B. K. R. has received consulting fees from Merck , Boehringer Ingelheim, GlycoMira, and Ionis and has research grants from the NIH and Cystic Fibrosis Foundation . None declared (S. E., K. H., A. R., R. S. I., D. C. B., P. G. G.). Funding Information: Author contributions: All authors participated in conceiving of the content to be covered in this article, writing specific sections of the first draft, and reading and editing and approving of the final draft that was prepared by L. M. and S. B. M. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: S. B. M. declares personal fees from Merck and NeRRe Therapeutics and grant support from Merck, the Australian National Health and Medical Research Council, and the Australian Research Council. L. M. reports personal fees from Chiesi, GSK, Merck, NeRRe Therapeutics, and Shionogi Inc; grant support from Merck; and other support from AstraZeneca, Boehringer Ingelheim, and Chiesi. A. B. C. has received fees from Up to Date, is on the data safety monitoring board for a vaccine study (Glaxo), is an advisor for study design of an unlicensed product (Merck), and has received multiple peer reviewed competitive grants from the Australian National Health and Medical Research Council. B. K. R. has received consulting fees from Merck, Boehringer Ingelheim, GlycoMira, and Ionis and has research grants from the NIH and Cystic Fibrosis Foundation. None declared (S. E. K. H. A. R. R. S. I. D. C. B. P. G. G.). ∗CHEST Expert Cough Panel Collaborators: Kenneth W. Altman, MD, PhD (Geisinger Commonwealth School of Medicine, Danville, PA); 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, England); Fiona Blackhall, MD, PhD (Department of Medical Oncology, University of Manchester, Manchester, England); Donald C. Bolser, PhD (College of Veterinary Medicine, University of Florida, Gainesville, FL); Sidney S. Braman, MD, FCCP (Mount Sinai Hospital, New York, NY); Christopher Brightling, MBBS, PhD, FCCP (University of Leicester, Glenfield Hospital, Leicester, England); Anne B. Chang, MBBS, PhD, MPH (Royal Children's Hospital, Brisbane, QLD, Australia); Andr{\'e}anne Cot{\'e}, MD (Institut universitaire de cardiologie et de pneumologie de Qu{\'e}bec, Quebec, QC, Canada); Peter Gibson, MBBS (Hunter Medical Research Institute, Newcastle, NSW, Australia); 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 (Respiratory Medicine, University of Calgary, Calgary, AB, Canada); Cynthia T. French, PhD, FCCP (UMass Memorial Medical Center, Worcester, MA); Cameron Grant, MBChB, PhD (University of Auckland, Auckland, New Zealand); Susan M. Harding, MD, FCCP (Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL); Anthony Harnden, MBChB (University of Oxford, Oxford, England); Adam T. Hill, MBChB, 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, England); Karina A. Keogh, MD (Mayo Clinic, Rochester, MN); Andrew P. Lane, MD (Johns Hopkins University School of Medicine, Baltimore, MD); J. Mark Madison, MD (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, Melbourne, VIC, Australia); Lorcan McGarvey, MD (The Queens University Belfast, Belfast, Northern Ireland); M. Hassan Murad, MD, MPH (Mayo Clinic, Rochester, MN); Mangala Narasimhan, DO, FCCP (Hofstra-Northwell Health, Manhasset, NY); Peter Newcombe, PhD (School of Psychology, University of Queensland, Brisbane, QLD, Australia); John Oppenheimer, MD (UMDNJ-Rutgers University, Livingston, NJ); Bruce Rubin, MEngr, MD, MBA (Virginia Commonwealth University, Richmond, VA); Richard J. Russell, MBBS (University of Leicester, Glenfield Hospital, Leicester, England); Jay H. Ryu, MD, FCCP (Mayo Clinic, Rochester, MN); Sonal Singh, MD, MPH (UMass Memorial Medical Center, Worcester, MA); Maeve P. Smith, MBChB, MD (University of Alberta, Edmonton, AB, Canada); Susan M. Tarlo, MBBS, FCCP (Toronto Western Hospital, Toronto, ON, Canada); and Anne E. Vertigan, PhD, MBA, BAppSc (SpPath) (John Hunter Hospital, Newcastle, NSW, Australia); Abd Moain Abu Dabrh, MBBCh, MS (Mayo Clinic, Jacksonville, FL), Vivek Iyer, MD, MPH Mayo Clinic, Rochester MN), Kefang Lai, MD, PhD (First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China), Kaiser Lim, MD (Mayo Clinic, Rochester, MN). Other contributions: We thank Nancy Harger, MLS, an education and clinical services librarian, working in the University of Massachusetts Medical School Library in Worcester, MA, who undertook all the searches for each section in this article. Publisher Copyright: {\textcopyright} 2021",

year = "2021",

month = oct,

doi = "10.1016/j.chest.2021.04.039",

language = "English (US)",

volume = "160",

pages = "1413--1423",

journal = "CHEST",

issn = "0012-3692",

publisher = "American College of Chest Physicians",

number = "4",

}

TY - JOUR

T1 - Global Physiology and Pathophysiology of Cough

T2 - Part 2. Demographic and Clinical Considerations: CHEST Expert Panel Report

AU - CHEST Expert Cough Panel

AU - McGarvey, Lorcan

AU - Rubin, Bruce K.

AU - Ebihara, Satoru

AU - Hegland, Karen

AU - Rivet, Alycia

AU - Irwin, Richard S.

AU - Bolser, Donald C.

AU - Chang, Anne B.

AU - Gibson, Peter G.

AU - Mazzone, Stuart B.

AU - Altman, Kenneth W.

AU - Barker, Alan F.

AU - Birring, Surinder S.

AU - Blackhall, Fiona

AU - Braman, Sidney S.

AU - Brightling, Christopher

AU - Coté, Andréanne

AU - El Solh, Ali A.

AU - Escalante, Patricio

AU - Field, Stephen K.

AU - Fisher, Dina

AU - French, Cynthia T.

AU - Grant, Cameron

AU - Harding, Susan M.

AU - Harnden, Anthony

AU - Hill, Adam T.

AU - Kahrilas, Peter J.

AU - Kavanagh, Joanne

AU - Keogh, Karina A.

AU - Lane, Andrew P.

AU - Madison, J. Mark

AU - Malesker, Mark A.

AU - Mazzone, Stuart

AU - Murad, M. Hassan

AU - Narasimhan, Mangala

AU - Newcombe, Peter

AU - Oppenheimer, John

AU - Rubin, Bruce

AU - Russell, Richard J.

AU - Ryu, Jay H.

AU - Singh, Sonal

AU - Smith, Maeve P.

AU - Tarlo, Susan M.

AU - Vertigan, Anne E.

N1 - Funding Information: Financial/nonfinancial disclosures: The authors have reported to CHEST the following: S. B. M. declares personal fees from Merck and NeRRe Therapeutics and grant support from Merck , the Australian National Health and Medical Research Council , and the Australian Research Council . L. M. reports personal fees from Chiesi , GSK, Merck , NeRRe Therapeutics, and Shionogi Inc; grant support from Merck; and other support from AstraZeneca , Boehringer Ingelheim, and Chiesi . A. B. C. has received fees from Up to Date, is on the data safety monitoring board for a vaccine study (Glaxo), is an advisor for study design of an unlicensed product ( Merck ), and has received multiple peer reviewed competitive grants from the Australian National Health and Medical Research Council . B. K. R. has received consulting fees from Merck , Boehringer Ingelheim, GlycoMira, and Ionis and has research grants from the NIH and Cystic Fibrosis Foundation . None declared (S. E., K. H., A. R., R. S. I., D. C. B., P. G. G.). Funding Information: Author contributions: All authors participated in conceiving of the content to be covered in this article, writing specific sections of the first draft, and reading and editing and approving of the final draft that was prepared by L. M. and S. B. M. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: S. B. M. declares personal fees from Merck and NeRRe Therapeutics and grant support from Merck, the Australian National Health and Medical Research Council, and the Australian Research Council. L. M. reports personal fees from Chiesi, GSK, Merck, NeRRe Therapeutics, and Shionogi Inc; grant support from Merck; and other support from AstraZeneca, Boehringer Ingelheim, and Chiesi. A. B. C. has received fees from Up to Date, is on the data safety monitoring board for a vaccine study (Glaxo), is an advisor for study design of an unlicensed product (Merck), and has received multiple peer reviewed competitive grants from the Australian National Health and Medical Research Council. B. K. R. has received consulting fees from Merck, Boehringer Ingelheim, GlycoMira, and Ionis and has research grants from the NIH and Cystic Fibrosis Foundation. None declared (S. E. K. H. A. R. R. S. I. D. C. B. P. G. G.). ∗CHEST Expert Cough Panel Collaborators: Kenneth W. Altman, MD, PhD (Geisinger Commonwealth School of Medicine, Danville, PA); 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, England); Fiona Blackhall, MD, PhD (Department of Medical Oncology, University of Manchester, Manchester, England); Donald C. Bolser, PhD (College of Veterinary Medicine, University of Florida, Gainesville, FL); Sidney S. Braman, MD, FCCP (Mount Sinai Hospital, New York, NY); Christopher Brightling, MBBS, PhD, FCCP (University of Leicester, Glenfield Hospital, Leicester, England); Anne B. Chang, MBBS, PhD, MPH (Royal Children's Hospital, Brisbane, QLD, Australia); Andréanne Coté, MD (Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, QC, Canada); Peter Gibson, MBBS (Hunter Medical Research Institute, Newcastle, NSW, Australia); 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 (Respiratory Medicine, University of Calgary, Calgary, AB, Canada); Cynthia T. French, PhD, FCCP (UMass Memorial Medical Center, Worcester, MA); Cameron Grant, MBChB, PhD (University of Auckland, Auckland, New Zealand); Susan M. Harding, MD, FCCP (Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL); Anthony Harnden, MBChB (University of Oxford, Oxford, England); Adam T. Hill, MBChB, 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, England); Karina A. Keogh, MD (Mayo Clinic, Rochester, MN); Andrew P. Lane, MD (Johns Hopkins University School of Medicine, Baltimore, MD); J. Mark Madison, MD (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, Melbourne, VIC, Australia); Lorcan McGarvey, MD (The Queens University Belfast, Belfast, Northern Ireland); M. Hassan Murad, MD, MPH (Mayo Clinic, Rochester, MN); Mangala Narasimhan, DO, FCCP (Hofstra-Northwell Health, Manhasset, NY); Peter Newcombe, PhD (School of Psychology, University of Queensland, Brisbane, QLD, Australia); John Oppenheimer, MD (UMDNJ-Rutgers University, Livingston, NJ); Bruce Rubin, MEngr, MD, MBA (Virginia Commonwealth University, Richmond, VA); Richard J. Russell, MBBS (University of Leicester, Glenfield Hospital, Leicester, England); Jay H. Ryu, MD, FCCP (Mayo Clinic, Rochester, MN); Sonal Singh, MD, MPH (UMass Memorial Medical Center, Worcester, MA); Maeve P. Smith, MBChB, MD (University of Alberta, Edmonton, AB, Canada); Susan M. Tarlo, MBBS, FCCP (Toronto Western Hospital, Toronto, ON, Canada); and Anne E. Vertigan, PhD, MBA, BAppSc (SpPath) (John Hunter Hospital, Newcastle, NSW, Australia); Abd Moain Abu Dabrh, MBBCh, MS (Mayo Clinic, Jacksonville, FL), Vivek Iyer, MD, MPH Mayo Clinic, Rochester MN), Kefang Lai, MD, PhD (First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China), Kaiser Lim, MD (Mayo Clinic, Rochester, MN). Other contributions: We thank Nancy Harger, MLS, an education and clinical services librarian, working in the University of Massachusetts Medical School Library in Worcester, MA, who undertook all the searches for each section in this article. Publisher Copyright: © 2021

PY - 2021/10

Y1 - 2021/10

N2 - Background: Cough characteristics vary between patients, and this can impact clinical diagnosis and care. The purpose of part two of this state-of-the-art review is to update the American College of Chest Physicians (CHEST) 2006 guideline on global physiology and pathophysiology of cough. Study Design and Methods: A review of the literature was conducted using PubMed and MEDLINE databases from 1951 to 2019 using prespecified search terms. Results: We describe the demographics of typical patients with cough in the clinical setting, including how cough characteristics change across age. We summarize the effect of common clinical conditions impacting cough mechanics and the physical properties of mucus on airway clearance. Interpretation: This is the second of a two-part update to the 2006 CHEST cough guideline; it complements part one on basic phenomenology of cough by providing an extended clinical picture of cough along with the factors that alter cough mechanics and efficiency in patients. A greater understanding of the physiology and pathophysiology of cough will improve clinical management.

AB - Background: Cough characteristics vary between patients, and this can impact clinical diagnosis and care. The purpose of part two of this state-of-the-art review is to update the American College of Chest Physicians (CHEST) 2006 guideline on global physiology and pathophysiology of cough. Study Design and Methods: A review of the literature was conducted using PubMed and MEDLINE databases from 1951 to 2019 using prespecified search terms. Results: We describe the demographics of typical patients with cough in the clinical setting, including how cough characteristics change across age. We summarize the effect of common clinical conditions impacting cough mechanics and the physical properties of mucus on airway clearance. Interpretation: This is the second of a two-part update to the 2006 CHEST cough guideline; it complements part one on basic phenomenology of cough by providing an extended clinical picture of cough along with the factors that alter cough mechanics and efficiency in patients. A greater understanding of the physiology and pathophysiology of cough will improve clinical management.

KW - airway clearance

KW - cough

KW - demographics

KW - mucus

KW - pathophysiology

KW - physiology

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UR - http://www.scopus.com/inward/citedby.url?scp=85117104516&partnerID=8YFLogxK

U2 - 10.1016/j.chest.2021.04.039

DO - 10.1016/j.chest.2021.04.039

M3 - Article

C2 - 33905678

AN - SCOPUS:85117104516

SN - 0012-3692

VL - 160

SP - 1413

EP - 1423

JO - CHEST

JF - CHEST

IS - 4

ER -

Global Physiology and Pathophysiology of Cough: Part 2. Demographic and Clinical Considerations: CHEST Expert Panel Report

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