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Weavers' cough — Clinical Guidelines

Overview

Weavers' cough, encompassing both acute and chronic forms, is a prevalent symptom often necessitating otolaryngological evaluation, particularly when persistent or complex. It can arise from various etiologies including infections, respiratory conditions, and psychogenic factors 1 8.

Diagnosis

History and Physical Examination: Essential for identifying underlying causes 1 8.

Chest Imaging: Chest X-ray may be useful, especially to rule out suppurative lung disease or structural abnormalities 16.

Pulmonary Function Tests: Recommended for evaluating suspected asthma 16.

Nasal Endoscopy: Useful in pediatric cases for assessing rhinosinusitis or foreign body aspiration 11.

Laryngoscopy: Considered for persistent or atypical presentations 8.

Specific Tests: Tailored based on clinical suspicion (e.g., allergy testing, sputum cultures) 2 11.

Management

Acute Cough: Often self-limiting; symptomatic relief with analgesics and hydration recommended 5.

Chronic Cough: Focus on identifying and treating underlying causes (e.g., GERD, asthma, rhinosinusitis) 2 4.

Pharmacological Treatments:

- Antitussives: Limited evidence; use cautiously, especially in children 5. - Antihistamines/Decongestants: May be considered for allergic triggers 3. - Bronchodilators: Useful in cases with asthma overlap 16.

Non-Pharmacological Approaches: Speech therapy shown to be effective in chronic cases 12.

Psychological Support: For psychogenic habit cough, combination of psychotherapy and relaxation techniques recommended 15.

Special Populations

Pediatrics: Acute cough often viral; chronic cough may indicate underlying conditions like asthma or rhinosinusitis 3 11 14.

Elderly: Increased risk of chronic cough due to comorbidities like GERD, COPD; thorough evaluation crucial 4.

Comorbidities: Consider GERD, asthma, and respiratory infections in management strategies 2 4 16.

Key Recommendations

Identify and Treat Underlying Causes: Prioritize diagnostic workup to address specific etiologies (Evidence: Strong 2 4).

Avoid Unnecessary Antibiotics and Cough Suppressants: Reserve use based on clinical evidence; avoid overprescribing (Evidence: Moderate 5).

Consider Psychological Factors in Chronic Cases: Evaluate and manage psychogenic cough with multidisciplinary approaches (Evidence: Expert opinion 15).

Utilize Speech Therapy for Chronic Cough: Evidence supports its efficacy in certain chronic cough syndromes (Evidence: Moderate 12).

References

1 Xu JR, Saraswathula A, Bryson PC, Carroll TL, Akst LM. Are Otolaryngologists Seeing More Cough? Longitudinal Trends and Patterns. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2025. link 2 Mukae H, Kaneko T, Obase Y, Shinkai M, Katsunuma T, Takeyama K et al.. The Japanese respiratory society guidelines for the management of cough and sputum (digest edition). Respiratory investigation 2021. link 3 Marseglia GL, Manti S, Chiappini E, Brambilla I, Caffarelli C, Calvani M et al.. Acute cough in children and adolescents: A systematic review and a practical algorithm by the Italian Society of Pediatric Allergy and Immunology. Allergologia et immunopathologia 2021. link 4 Kardos P, Dinh QT, Fuchs KH, Gillissen A, Klimek L, Koehler M et al.. German Respiratory Society guidelines for diagnosis and treatment of adults suffering from acute, subacute and chronic cough. Respiratory medicine 2020. link 5 Oat-Judge J. Clinical Updates in Women's Health Care Summary: Acute Cough: Primary and Preventive Care Review. Obstetrics and gynecology 2019. link 6 Morice AH, Shanks G. Pharmacology of cough in palliative care. Current opinion in supportive and palliative care 2017. link 7 Usmani OS, McGarvey LP. Clinical posters discussion: summary. Pulmonary pharmacology & therapeutics 2011. link 8 Altman KW, Irwin RS. Cough: a new frontier in otolaryngology. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2011. link 9 Kardos P, Berck H, Fuchs KH, Gillissen A, Klimek L, Morr H et al.. Guidelines of the German Respiratory Society for diagnosis and treatment of adults suffering from acute or chronic cough. Pneumologie (Stuttgart, Germany) 2010. link 10 McGarvey LP, Elder J. Future directions in treating cough. Otolaryngologic clinics of North America 2010. link 11 Chang AB, Berkowitz RG. Cough in the pediatric population. Otolaryngologic clinics of North America 2010. link 12 Widdicombe J, Fontana G, Gibson P. Workshop--cough: exercise, speech and music. Pulmonary pharmacology & therapeutics 2009. link 13 Han YM, Yoo JH, Suh JS. Sonographic appearance of a tear of the lateral internal oblique muscle resulting from cough. Journal of clinical ultrasound : JCU 2005. link 14 Chang AB, Powell CV. Non-specific cough in children: diagnosis and treatment. Hospital medicine (London, England : 1998) 1998. link 15 Gay M, Blager F, Bartsch K, Emery CF, Rosenstiel-Gross AK, Spears J. Psychogenic habit cough: review and case reports. The Journal of clinical psychiatry 1987. link 16 Mellis C. Children with cough. Australian family physician 1984. link

Weavers' cough