Senior Consultant Pulmonologist, Department of Pulmonology, Divyajyot CHS Ltd Bldg, Goregaon, Mumbai, Maharashtra.
Senior Consultant Pulmonologist, Department of Pulmonology, MGM Healthcare Hospital, Chennai, Tamil Nadu.
J Assoc Physicians India. 2023 Jun;71(6):11-12. doi: 10.5005/japi-11001-0275.
Cough has a prevalence of 9.6% globally and 5-10% in India. Though it is a reflex action, it affects an individual's quality of life (QoL) when uncontrolled. There was a need to create an integrated guidance document on managing cough focused on primary care physicians in the Indian setting. This consensus intends to bridge this gap by providing clinical recommendations to diagnose and manage cough in primary healthcare in India.
The modified Delphi method was used to arrive at a consensus on clinical statements. The panel comprised 10 experts, including pulmonologists, otolaryngologists, a pediatrician, and a general physician. The statements were discussed under the following domains: definition, etiology, diagnosis, and treatment.
A total of 109 clinical statements were framed, with 75 reaching consensus, 13 reaching near consensus, and 21 reaching no consensus. The experts recommended empiric use of nonopioid antitussive agents for symptomatic relief of acute dry cough. The use of oral antihistamines, oral decongestants, or mucoactive agents as a part of fixed-dose combinations (FDCs) in cough associated with rhinitis or upper airway cough syndrome (UACS) can be considered for symptomatic relief. Maintaining good hydration is important to manage a productive cough. Codeine-based preparations are to be considered as a last resort in patients with an unexplained chronic cough when other treatments have failed. Additionally, insights were captured on red flag signs, nonpharmacologic therapy, special populations, and referral to higher centers. Experts have also proposed a management algorithm with an integrated care pathway approach for acute, subacute, and chronic coughs.
The present consensus fills the existing need and may guide the physician to successfully diagnose and manage cough in the primary healthcare setting in India.
咳嗽在全球的患病率为 9.6%，在印度为 5-10%。尽管咳嗽是一种反射动作，但当它不受控制时，会影响个体的生活质量（QoL）。因此，需要在印度基层医疗环境下为初级保健医生创建一份综合的咳嗽管理指导文件。本共识旨在通过为印度初级医疗保健中咳嗽的诊断和管理提供临床建议来填补这一空白。
采用改良 Delphi 法就临床陈述达成共识。该小组由 10 名专家组成，包括肺科医生、耳鼻喉科医生、儿科医生和全科医生。陈述在以下领域进行了讨论：定义、病因、诊断和治疗。
共制定了 109 项临床陈述，其中 75 项达成共识，13 项达成接近共识，21 项未达成共识。专家建议经验性使用非阿片类镇咳药来缓解急性干咳的症状。在与鼻炎或上气道咳嗽综合征（UACS）相关的咳嗽中，可考虑使用口服抗组胺药、口服减充血剂或黏液活性剂作为固定剂量组合（FDCs）的一部分来缓解症状。保持良好的水分摄入对于管理有痰咳嗽很重要。在其他治疗方法失败时，对于不明原因的慢性咳嗽患者，可考虑使用可待因类制剂作为最后的手段。此外，还就危险信号、非药物治疗、特殊人群和转诊到上级中心等方面获得了一些见解。专家还提出了一个管理算法，以及急性、亚急性和慢性咳嗽的综合护理途径方法。
本共识满足了现有需求，并可能指导医生在印度基层医疗环境中成功诊断和管理咳嗽。
