Chronic cough guidance backs specialist nurse input

New guidance that aims to support respiratory nurses and other clinicians with the management of chronic cough in routine clinical practice has been published by the British Thoracic Society.

“We hope the statement provides clear practical guidance on the management of cough”

Sean Parker

The society said it hoped that is new Clinical Statement on Chronic Cough in Adults, published in the journal Thorax, would be of value to a wide range of professionals, including respiratory nurses.

It noted that chronic cough was a commonly presenting respiratory illness seen by clinicians across both primary and secondary care, with potentially up to 10% of people in the UK being affected.

The society said that the new clinical statement was intended to promote clinical advances that had occurred since the BTS Guideline on Chronic Cough in Adults, which was published in Thorax in 2006.

“There has been major progress in the diagnosis, and therapy of this condition but it remains a challenging area with a limited evidence base,” it said.

“Clinical advances, particularly the recognition of cough hypersensitivity syndrome and the use of appropriate drug and non-pharmacological cough treatment, has not yet embedded in most routine clinical practice in the UK.

“The objective of this statement is to distil recent progress into practical recommendations to improve the management of this common and frequently misunderstood disease,” it added.

The document also acknowledged that there was a diverse range of ‘treatable traits’ related to cough, including detail on specific clinical practice points, and the different treatments options.

In addition, the clinical statement highlighted the importance of involving the multidisciplinary respiratory workforce in the treatment and management of cough.

The incorporation of therapists, specialist nurses and physiotherapists should be considered a vital component of delivering effective and cost-effective non-pharmacological cough treatment, it said.

The statement said: “Care for patients with [chronic cough] is multidisciplinary. Specialist nurse input is beneficial and the role should be developed.”

It also suggested that a cough does not usually require particularly specialised procedures and could largely be dealt with in general practice.

“Chronic cough poses a widespread respiratory challenge, involving clinicians across all disciplines”

Tricia Bryant

As a result, the statement outlines a high-level workforce framework that it said could be generally applied across the UK to help to support primary care.

Co-chair of the BTS Clinical Statement Group on Chronic Cough in Adults, Dr Sean Parker, acknowledged that chronic cough was difficult for both patients and clinicians.

“We hope the statement provides clear practical guidance on the management of cough grounded in routine clinical practice,” he said.

“The treatable traits framework emphasises a pragmatic, personalised approach rather than rigid treatment protocols.”

He added: “We encourage clinicians to think about how services are delivered and to develop respiratory speech therapy services as an essential part of all respiratory multidisciplinary teams.”

Meanwhile, the BTS noted that current scientific evidence relating to chronic cough was limited, meaning that there was “considerable opportunity” to continue to advance research in this area.

Through the clinical statement and other ways, the BTS said it aimed to continue to support clinicians and patients treating and managing chronic cough.

Co-chair of the BTS Clinical Statement Group on Chronic Cough in Adults, Professor Jacky Smith, said: “A number of new therapies are currently in development to address refractory chronic cough, the first of which has recently been licensed in the European Union.

“We hope this clinical statement lays the groundwork for more efficient evaluation of patients and ultimately access to new effective treatments for those whose cough is refractory to treatment of underlying conditions,” she added.

Commenting on the statement, Tricia Bryant, executive director of the Primary Care Respiratory Society, said: “Chronic cough poses a widespread respiratory challenge, involving clinicians across all disciplines.

“Recognising the role of primary care, the statement endorses a workforce framework to support general practice, highlighting the indispensable contributions of speech and language therapists, specialist nurses, and physiotherapists.”

Ms Bryant, a nurse by background, said the Primary Care Respiratory Society echoed this sentiment and that it affirmed the significance of this collaborative approach to care.

She added: “The clinical statement not only propels the call for ongoing research but also establishes a platform for enhancing the understanding and management of chronic cough.

“Essentially, this statement signifies not just progress but sets the groundwork for a future where the management of chronic cough becomes more precise, inclusive and effective.”