Cough is a common symptom experienced by athletes, particularly after exercise. We performed a systematic review to assess in this population: 1) the main etiologies of acute and recurrent cough, either exercise-induced or not; 2) how it is assessed; and 3) how cough is treated in this population. From the systematic review, suggestions for management were developed.
ology: This review was done according to the CHEST methodological guidelines and GRADE framework up to April 2015. To be included, studies had to meet the following criteria: participants had to be athletes, adults and adolescents aged ≥ 12 years, and complaining of cough, regardless of its duration or relation with exercise. The Expert Cough Panel based their suggestions on the data extracted from the review and final grading by consensus according to a Delphi process.
Only 60 reports fulfilled the inclusion criteria and the results of our analysis revealed only low quality evidence on cough etiology and to support how to assess and treat cough specifically in athletes. Although there was no formal evaluation of causes of cough in the athlete population, the most common etiologies reported were asthma, exercise-induced bronchoconstriction, respiratory tract infections, upper airway cough syndrome (mostly from rhinitis) and environmental exposures. Cough was also reported to be related to exercise-induced vocal cord dysfunction among a variety of less common etiologies. Although gastroesophageal reflux disease (GERD) is frequent in athletes, we found no publication on cough and GERD in this population. Assessment of cough etiologies was mainly done with bronchoprovocation tests and suspected disease-specific investigations. The evidence to guide treatment of cough in the athlete was weak or non-existent, depending on the etiology. As data on cough in athletes were hidden in a set of other data (respiratory symptoms), evidence tables were difficult to produce, and were done only for cough treatment in athletes.
Etiology of cough in the athlete appears to differ slightly from the general population. It is often related to environmental exposures related to the sport training environment and occurs predominantly following intense exercise. Clinical history and specific investigations should allow identification of the etiology of cough and targeting the treatment. Until management studies have been performed in the athlete, current guidelines that exist for the general population should be applied for the evaluation and treatment of cough in the athlete taking into account specific training context and anti-doping regulations.