TABLE 1.
Statements that achieved consensus
Statement | Positive response (8–10), % | |
1 | Specialist cough clinics should be established to provide the optimal care for patients with chronic cough and refractory cough. | 84.9 |
2 | Aims of specialist cough clinics should be to improve patient outcomes, optimise investigations and treatment, reduce burden of disease, and advance clinical research through patient registries and interventional clinical trials. | 94.3 |
3 | Specialist cough clinics should be supervised by clinicians with expertise in cough management. | 96.2 |
4 | Specialist cough clinics should provide evaluation and management of chronic cough patients guided by the agreed national and/or international consensus. Such standardised management should also be encouraged in general respiratory, allergy or ENT clinics responsible for the care of patients with chronic cough. | 90.6 |
6 | Cough should be routinely assessed at baseline and follow-up, using a rating scale for cough severity (such as 0–10 score, modified Borg scale, a 0–100 visual analogue scale or an appropriate alternative). Cough-specific quality of life should also be a part of the assessment at specialist cough clinics, particularly for research purposes. | 73.6 |
7 | Cough triggers and cough complications should be a part of routine history taking, preferably by means of validated measurement tools. | 83.0 |
8 | In every patient newly referred with chronic cough, a minimum panel of routine tests should be reviewed, or undertaken if not already performed. The minimum panel of tests are 1) chest X-ray, 2) spirometry (with bronchodilator testing if indicated) and 3) a type 2 inflammatory marker (such as blood eosinophils, fractional exhaled nitric oxide (FENO) or sputum eosinophils). | 96.2 |
9 | Decision to commence opiates (as anti-tussive therapy) should be made by clinicians with expertise in cough management. | 90.6 |
10 | Decision to commence current neuromodulators (such as gabapentin or amitriptyline, as anti-tussive therapy) should be made by clinicians with expertise in cough management. | 88.7 |
11 | Cough control therapy, or speech language and pathology therapy, should be available in specialist cough clinics. | 90.6 |
12 | In specialist cough clinics, multidisciplinary team meetings should take place to discuss complex cough patients. | 81.1 |
13 | Specialist cough clinics should offer opportunities to patients to participate in clinical research or trials of novel cough therapies. | 94.3 |
14 | Specialist cough clinics should participate in local and international audit on an ongoing basis with the aim of providing a high-quality cough service. | 83.0 |
15 | Cough evaluation and management should be integrated into the post-graduate specialty (e.g. respiratory, allergy or ENT) training curriculum. | 96.2 |
16 | Specialty trainees/fellows (e.g. respiratory, allergy or ENT) should be required to undertake a period of training/participate in clinics which regularly receive referrals for chronic cough. | 92.5 |
ENT: ear, nose and throat.