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Evidence-Based Medicine |

Occupational and Environmental Contributions to Chronic Cough in Adults: Chest Expert Panel Report

Susan M. Tarlo, MB BS, FCCP; Kenneth W. Altman, MD, PhD; John Oppenheimer, MD; Kaiser Lim, MD; Anne Vertigan, PhD, MBA, BAppSc (Sp Path); David Prezant, MD; Richard S. Irwin, MD, Master FCCP
Author and Funding Information

Summary conflict of interest: The authors have no conflicts of interest

External funding: none

This report has been endorsed by the following organizations: American College of Allergy, Asthma, and Immunology; American Association for Respiratory Care; Asian Pacific Society for Respirology; Canadian Thoracic Society; and Occupational and Environmental Medicine Association of Canada.

1Division of Respiratory Medicine, Toronto Western Hospital, University of Toronto, Canada

2Department of Otolaryngology-Head & Neck Surgery, the Baylor College of Medicine, Houston, Texas

3University Medical and Dental School of New Jersey-Rutgers University, NJ

4Pulmonary & Crit Care Med Mayo Clinic Rochester Mayo College of Medicine Rochester, MN

5John Hunter Hospital, New South Wales, Australia

6Chief Medical Officer, Fire Department of the City of New York, Brooklyn NY

7Division of Pulmonary, Allergy and Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA

Correspondence to: Dr Susan M Tarlo, MB BS, Toronto Western Hospital EW7-449, 399 Bathurst St, Toronto, Ontario M5T 2S8, Canada E mail .


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.07.029
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Abstract

Background  In response to occupational and environmental exposures, cough can be an isolated symptom reflecting exposure to an irritant with little physiological consequence, or can be a manifestation of more significant disease. This document reviews occupational and environmental contributions to chronic cough in adults, focusing on aspects not previously covered in the 2006 ACCP Cough Guideline or our more recent systematic review, and suggests an approach to investigation of these factors when suspected.

Methods  Medline and Toxline literature searches were supplemented by articles identified by the cough panel occupational and environmental subgroup members, to identify occupational and environmental aspects of chronic cough not previously covered in the 2006 ACCP Cough Guideline. Based on the literature reviews and the Delphi methodology, the cough panel occupational and environmental subgroup developed guideline suggestions that were approved after review and voting by the full cough panel.

Results  The literature review identified relevant articles regarding: mechanisms; allergic environmental causes; chronic cough and the recreational and involuntary inhalation of tobacco and marijuana smoke; non-allergic environmental triggers; laryngeal syndromes; and occupational diseases and exposures. Consensus-based statements were developed for the approach to diagnosis, due to a lack of strong evidence from published literature.

Conclusions  Despite increased understanding of cough related to occupational and environmental triggers, there remains a gap between the recommended assessment of occupational and environmental causes of cough and the reported systematic assessment of these factors, and a need for further documentation of this in the future.


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