ACR Appropriateness Criteria® Chronic Cough

Area of Science:

• Pulmonology
• Radiology
• Evidence-based Medicine

Background:

• Chronic cough, defined as lasting at least 8 weeks, presents diagnostic challenges due to multifactorial etiologies including smoking-related lung disease, upper airway cough syndrome, asthma, and gastroesophageal reflux disease.
• The complex pathophysiology and variable clinical presentations of chronic cough necessitate a structured approach to evaluation and management.
• Current evidence guiding the use and timing of imaging modalities in chronic cough assessment is limited, highlighting a need for evidence-based recommendations.

Framework:

• The American College of Radiology Appropriateness Criteria provide evidence-based guidelines for medical imaging in specific clinical conditions.
• These guidelines are developed and revised annually by a multidisciplinary expert panel, involving extensive literature analysis.
• Methodologies such as the RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) are employed to rate the appropriateness of imaging procedures.

Implementation:

• Imaging plays a role in the initial evaluation of chronic cough, but optimal utilization requires clear guidance.
• The Appropriateness Criteria aim to standardize and optimize the use of imaging in the diagnostic workup of chronic cough.
• Expert opinion may supplement evidence in cases where data is lacking or equivocal to guide imaging decisions.

Implications:

• These evidence-based guidelines can assist clinicians in making informed decisions regarding imaging for patients with chronic cough.
• Standardized imaging protocols may improve diagnostic accuracy and patient outcomes for chronic cough.
• Further research is needed to strengthen the evidence base for imaging in chronic cough evaluation.