GuidelineThe Japanese respiratory society guidelines for the management of cough and sputum (digest edition)
Section snippets
Mechanism of cough development
Coughing is a physiological defense reaction that aims to eliminate the secretions retained in the airway or inhaled foreign substances outside the airway. Involuntary cough reflex with the vagal nerve as an afferent pathway and voluntary cough initiated via the cerebral cortex (e.g., urge to cough [1]) are involved in cough development (Fig. 1). An urge or feeling that one is likely to cough is the sensation that is generated before cough development when the cough receptor in the airway is
Definition of the terms related to sputum
Sputum is a general term for airway secretions expectorated from the lower airway (Table 3). After exceeding the physiological excretion capacity of mucociliary transportation, the secretions retained in the airway stimulate the cough receptors and are excreted as sputum by coughing (cough clearance). Excess airway secretions are mainly derived from mucin production in mucus-producing cells and hypersecretion. This reaction is not only triggered as a biological defense reaction against various
Management of acute cough (up to three weeks: see Flow Chart 1; Fig. 4)
The management of adult patients with acute cough (up to three weeks after onset) who present to hospital is shown in Flow Chart 1 (Fig. 4). The general procedure is shown below (3.1–3.4).
Management of prolonged or chronic cough (longer than three weeks: Flow Chart 2; Fig. 5)
When adult patients with a prolonged or chronic cough present to hospital (three weeks or more from the onset), there may be multiple etiologies, changes in etiology over time, or self-healing of post-infectious cough at play. Therefore, it is important to be flexible in your diagnosis, as described in ∗1 in Flow Chart 2 (Fig. 5). It is recommended first to explore whether there is a single or major cause of the cough. However, it should be noted that there may be multiple causes.
5-1 Recent topics and future perspectives
The basic tenet of this guideline is to first identify the causative disease(s) and then administer specific treatment without using non-specific therapeutic drugs as much as possible. However, a significant proportion of patients, especially those in specialty outpatient clinics, respond poorly to the treatment given for an assumed cause [14,56,57]. Recently, causative diseases such as organ-specific autoimmune diseases and ventricular premature contraction have been reported. In addition,
Conflict of Interest
Dr. Hiroshi Mukae received honoraria from Daiichi Sankyo Co., Ltd., Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., KYOLIN Pharmaceutical Co., Ltd., Pfizer Japan Inc., MSD K.K., Taisho Pharma Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd., Astellas Pharma Inc., and AstraZeneca K.K., a research grant from Nippon Boehringer Ingelheim Co., Ltd., and subsidies or donations from Fujifilm Toyama Chemical Co., Ltd., Taiho Pharmaceutical Co., Ltd., Chugai Pharmaceutical Co., Ltd., Meiji
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