Burning chest cough
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Understanding Burning Chest Cough: Causes and Management
Acute Cough: Common Causes and Management
Acute cough, defined as lasting less than three weeks, is frequently caused by respiratory infections, predominantly viral in nature. Other common causes include exacerbations of underlying conditions such as asthma, chronic obstructive pulmonary disease (COPD), and pneumonia1. The 2006 CHEST Cough Guidelines, which have been validated and updated in 2017, provide a useful framework for diagnosing and managing acute cough. Despite the high risk of bias in the studies reviewed, these guidelines remain a valuable tool for clinicians worldwide1.
Subacute Cough: Postinfectious and Underlying Conditions
Subacute cough, lasting between three to eight weeks, is often a result of postinfectious cough or exacerbations of underlying diseases like asthma, COPD, and upper airway cough syndrome (UACS)1. The CHEST guidelines emphasize the importance of considering these conditions when evaluating a patient with a subacute cough. Although the evidence quality is low, the guidelines have been instrumental in guiding clinical practice, particularly in Asian countries where the studies were conducted1.
Chronic Cough: Multifactorial Causes and Treatment
Chronic cough, defined as lasting more than eight weeks, has a more complex etiology. The most common causes include UACS from rhinosinus conditions, asthma, gastroesophageal reflux disease (GERD), and nonasthmatic eosinophilic bronchitis. These conditions often coexist, making diagnosis and treatment challenging1. The updated CHEST guidelines provide a comprehensive approach to managing chronic cough, incorporating advances in understanding and treatment since 20061.
Pediatric Chronic Cough: Special Considerations
In children, chronic cough (lasting more than four weeks) is a prevalent issue that often leads to medical consultations. The updated CHEST guidelines for pediatric chronic cough emphasize the use of management algorithms and appropriate antibiotics for wet/productive cough2. While there is high-quality evidence supporting some aspects of pediatric cough management, there remains a significant gap in evidence, particularly for non-specific coughs in community settings2. Further research is needed to enhance the management of chronic cough in children, especially in primary healthcare environments2.
Conclusion
Burning chest cough can be a symptom of various underlying conditions, ranging from acute viral infections to chronic diseases like asthma and GERD. The CHEST guidelines, both for adults and children, provide a structured approach to diagnosing and managing cough based on its duration and associated conditions. Despite some limitations in evidence quality, these guidelines are essential tools for clinicians worldwide, helping to improve patient outcomes through systematic and evidence-based management strategies.
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Most relevant research papers on this topic
Classification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report
CHEST's 2006 Cough Guidelines and management algorithms for acute, subacute, and chronic cough in adults are useful in diagnosing and treating patients globally, despite low quality evidence.
Systematic Review
Highly CitedManaging Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report.
CHEST guidelines for children show some high-quality evidence in managing chronic cough, but more research is needed for non-specific cough management in primary healthcare.
Systematic ReviewHighly CitedSymptomatic Treatment of Cough Among Adult Patients With Lung Cancer: CHEST Guideline and Expert Panel Report
The current CHEST Cough Guideline is more specific and follows a step-up approach to managing cough in lung cancer patients, acknowledging the need for more effective, evidence-based interventions through high-quality research.
Systematic ReviewGlobal physiology and pathophysiology of cough: Part 1. Cough phenomenology: CHEST Guideline and Expert Panel report.
This update to the 2006 CHEST Cough Guideline provides a more comprehensive understanding of cough phenomenology, enhancing our understanding of clinical relevance and patient care.
Systematic ReviewMethodologies for the development of the management of cough: CHEST guideline and expert panel report.
CHEST guidelines on cough management are based on rigorous methodology and transparency, meeting the Institute of Medicine's trustworthiness guidelines and providing direction for healthcare providers and patients.
Systematic ReviewCough in the Athlete: CHEST Guideline and Expert Panel Report
Cough in athletes is often caused by asthma, exercise-induced bronchoconstriction, respiratory tract infections, and environmental exposures, and should be assessed and treated using general population guidelines.
Systematic ReviewGlobal physiology and pathophysiology of cough: Part 2. Demographic and clinical considerations: CHEST Expert Panel report.
This update to the 2006 CHEST Cough Guideline focuses on demographics, common clinical conditions, and factors that impact cough mechanics and efficiency, improving clinical management.
Systematic ReviewChronic Cough Due to Stable Chronic Bronchitis: CHEST Expert Panel Report.
The evidence supporting the management of chronic cough due to chronic bronchitis is limited and of low quality, but this guideline provides guidance on treatment based on the best available evidence and identifies gaps in our knowledge for future research.
Systematic ReviewManaging cough as a defense mechanism and as a symptom. A consensus panel report of the American College of Chest Physicians.
Since 1935, CHEST has been the leading source of authoritative information on chest diseases and treatments.
Highly CitedCough in Ambulatory Immunocompromised Adults: CHEST Expert Panel Report
The initial diagnostic algorithm for cough in immunocompromised patients should be similar to that for immunocompetent individuals, but consider the type and severity of immune defect, geographic location, and social determinants.
Systematic Review