Management of acute cough: recommendations and evaluation of clinical guidelines according to AGREE II

Luane Michel Winck; Marcela Mofati Boechat; Bárbara Manuella Cardoso Sodré Alves; Debora Santos Lula Barros; Rodrigo Fonseca Lima; Tiago Marques dos Reis; Rafael Santana

doi:10.5712/rbmfc20(47)3991

Authors

Luane Michel Winck Universidade de Brasília – Brasília (DF), Brazil. https://orcid.org/0000-0003-0235-8084
Marcela Mofati Boechat Universidade de Brasília – Brasília (DF), Brazil. https://orcid.org/0000-0001-7349-1099
Bárbara Manuella Cardoso Sodré Alves Universidade de Brasília – Brasília (DF), Brazil. https://orcid.org/0000-0001-9875-4334
Debora Santos Lula Barros Universidade de Brasília – Brasília (DF), Brazil. https://orcid.org/0000-0001-6459-7457
Rodrigo Fonseca Lima Universidade de Brasília – Brasília (DF), Brazil. https://orcid.org/0000-0001-8173-4425
Tiago Marques dos Reis Universidade Federal de Alfenas – Alfenas (MG), Brazil. https://orcid.org/0000-0002-0789-0187
Rafael Santana Universidade de Brasília – Brasília (DF), Brazil. https://orcid.org/0000-0003-4481-210X

DOI:

https://doi.org/10.5712/rbmfc20(47)3991

Keywords:

Quality of health care, Evidence-based practice, Clinical practice guidelines, Cough

Abstract

Introduction: Cough is one of the main causes of demand for care in primary care, as it affects the patient’s quality of life. An acute cough is considered a self-limiting problem because it is of low severity and has a short latency period. Objective: The aim of this study was to evaluate the quality of clinical guidelines (CGs) for the treatment of acute cough. Methods: Searches were carried out on the websites of national and international institutions and organizations using the descriptors “cough,” “tos,” “practice guideline,” “guideline,” and “guide of clinical practice.” The selected guidelines were evaluated by four reviewers using the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument, and then, they were classified as strongly recommended, recommended with modifications, and non-recommended. Results: A total of 11 international guidelines were selected, published between 2006 and 2019, most from the United States of America. A total of seven guidelines were specific to the treatment of acute cough, only one guideline was focused on pharmaceutical care, and six were focused on the treatment of adults and children. Scope and purpose were the domains that presented the best score; editorial independence (D6) had the highest score variation (0–98%); and applicability (D5) of guidelines had the lowest mean score, 46% (range 2–88%). Regarding interventions, most of the guidelines referred to pharmacological interventions as unnecessary and the most cited non-pharmacological intervention was menthol (ointment). Conclusions: Therefore, it is necessary to carry out more clinical studies of good quality so that the CGs can be revised, to make the recommendations more reliable.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Instrumento para Avaliação de Diretrizes Clínicas. Instrumento [Internet]. Consórcio Agree; 2009 [cited on May 02, 2023]. Available at: https://www.agreetrust.org/wp-content/uploads/2013/06/AGREE_II_Brazilian_Portuguese.pdf

Kardos P, Dinh QT, Fuchs KH, Gillissen A, Klimek L, Koehler M, et al. Guidelines of the German Respiratory Society for diagnosis and treatment of adults suffering from acute, subacute and chronic cough. Pneumologie. 2019;73(3):143-80. https://doi.org/10.1055/a-0808-7409

Speich B, Thomer A, Aghlmandi S, Ewald H, Zeller A, Hemkens LG. Treatments for subacute cough in primary care: Systematic review and meta-analyses of randomised clinical trials. Br J Gen Pract. 2018;68(675):e694-e702. https://doi. org/10.3399/bjgp18X698885

Morice AH, McGarvey L, Pavord I; British Thoracic Society Cough Guideline Group. Recommendations for the management of cough in adults. Thorax. 2006;61(Suppl 1):i1-24. https://doi.org/10.1136/thx.2006.065144

Irwin RS, Metersky M, van Zuuren EJ, Trow TK. Acute and subacute cough – approach to the patient [Internet]. DynaMed; 2019 [cited on August 5, 2025]. Available from: https://www.dynamed.com/approach-to/acute-and-subacute-cough-approach- to-the-patient

Weinberger SE, Saukkonen K. Evaluation and treatment of subacute and chronic cough in adults [Internet]. UpToDate; 2025 [cited on Apr 15, 2023]. Available at: https://www.uptodate.com/contents/evaluation-and-treatment-of-subacute-and-chronic- cough-in-adults

National Institute for Health and Care Excellence. Cough (acute): antimicrobial prescribing [Internet]. NICE guideline; 2019 [cited on Apr 15, 2023]. Available at: https://www.nice.org.uk/guidance/ng120

De Blasio F, Virchow JC, Polverino M, Zanasi A, Behrakis PK, Kilinç G, et al. Cough management: a practical approach. Cough. 2011;7(1):7. https://doi.org/10.1186/1745-9974-7-7

Jiang M, Guan WJ, Fang ZF, Xie YQ, Xie JX, Chen H, et al. A critical review of the quality of cough clinical practice guidelines. Chest. 2016;150(4):777-88. https://doi.org/10.1016/j.chest.2016.04.028

Morice AH. Developing antitussives the clinician’s pipeline-what do we need? J Thorac Dis. 2014;6(Suppl 7):S735-8. https:// doi.org/10.3978/j.issn.2072-1439.2014.08.40

Nitsche MP, Carreño M. Is honey an effective treatment for acute cough in children? Medwave. 2016;16 Suppl 2:e6454. https://doi.org/10.5867/medwave.2016.6454

Dal Negro RW, Turco P, Povero M. Cost of acute cough in Italian children. Clinicoecon Outcomes Res. 2018;10:529-37. https://doi.org/10.2147/CEOR.S167813

El-Gohary M, Hay AD, Coventry P, Moore M, Stuart B, Little P. Corticosteroids for acute and subacute cough following respiratory tract infection: a systematic review. Fam Pract. 2013;30(5):492-500. https://doi.org/10.1093/fampra/cmt034

Collins JC, Moles RJ. Management of respiratory disorders and the pharmacist’s role: cough, colds, and sore throats and allergies (including eyes). Encyclopedia of Pharmacy Practice and Clinical Pharmacy. 2019;23;282-91. https://doi. org/10.1016/B978-0-12-812735-3.00510-0

Correr CJ. Farmácia clínica e a prestação de serviços farmacêuticos. Curitiba: Editora Practice; 2016.

Conselho Federal de Farmácia. Curso Online. Prescrição farmacêutica no manejo de problemas de saúde autolimitados: modulo 2: unidade 3: documentação do processo de atendimento e da prescrição farmacêutica [Internet]. Brasília: Conselho Federal de Farmácia; 2015 [cited on May 20, 2025]. Available at: https://www.cff.org.br/userfiles/Apostila%20-3.pdf

Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologi, Inovação e Complexo da Saúde. Departamento de Gestão e Incorporação de Tecnologias em Saúde. Diretrizes metodológicas: elaboração de diretrizes clínicas. Brasília: Ministério da Saúde.; 2023.

Ronsoni RM. Avaliação dos protocolos clínicos e diretrizes terapêuticas do Ministério da Saúde segundo método AGREE II (Appraisal of Guidelines for Research and Evaluation) [dissertação de mestrado]. Rio de Janeiro: Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sérgio Arouca; 2013.

Lai K, Shen H, Zhou X, Qiu Z, Cai S, Huang K, et al. Clinical Practice Guidelines for Diagnosis and Management of Cough-Chinese Thoracic Society (CTS) asthma consortium. J Thorac Dis. 2018;10(11):6314-51. https://doi.org/10.21037/ jtd.2018.09.153

Ocaña Arenas A, Baos V, Amariles Muñoz P, Palop Larrea V, Sáez-Benito Suescun L, Sempere Verdú E, et al. Protocolos de indicación farmacéutica y criterios de derivación al médico en síntomas menores [Internet]. Granada: Universidad de Granada; 2008 [cited on May 20, 2023]. Available at: https://digibug.ugr.es/handle/10481/33050

Holzinger F, Beck S, Dini L, Stöter C, Heintze C. Diagnoseund therapie des akuten hustens bei erwachsenen. Dtsch Arztebl Int. 2014;111:356-63. https://doi.org/10.3238/arztebl.2014.0356

Elamin EI, Ibrahim MIM, Sulaiman SAS, Muttalif AR. Cost of illness of tuberculosis in Penang, Malaysia. Pharm World Sci. 2008;30(3):281-6. https://doi.org/10.1007/s11096-007-9185-0

Bolser DC. Cough suppressant and pharmacologic protussive therapy: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl.):238S-49S. https://doi.org/10.1378/chest.129.1_suppl.238S

Malesker MA, Callahan-Lyon P, Ireland B, Irwin RS, CHEST Expert Cough Panel. Pharmacologic and nonpharmacologic treatment for acute cough associated with the common cold: CHEST Expert Panel Report. Chest. 2017;152(5):1021-37. https://doi.org/10.1016/j.chest.2017.08.009

National Institute for Health and Care Excellence. Respiratory tract infections (selflimiting): prescribing antibiotics [Internet]. NICE guideline; 2017 [cited on Mau 20, 2023]. Available at: https://www.nice.org.uk/guidance/cg69

Pratter MR. Cough and the common cold: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):72S- 74S. https://doi.org/10.1378/chest.129.1_suppl.72S

Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):1S-23S. https://doi. org/10.1378/chest.129.1_suppl.1S

Santana RS, Lupatini EO, Zanghelini F, Ronsoni RM, Rech N, Leite SN. The different clinical guideline standards in Brazil: High-cost treatment diseases versus poverty-related diseases. PLoS One. 2018;13(10):e0204723. https://doi.org/10.1371/ journal.pone.0204723

Conselho Federal de Farmácia. Guia de prática clínica: sinais e sintomas respiratórios: tosse. Brasília: Conselho Federal de Farmácia; 2019.