Referral pathway for adults with chronic cough in Switzerland from a Delphi-based consensus study

The etiology of chronic cough (CC) is varied, making it difficult to manage, particularly when the cough persists despite appropriate treatment of underlying disease (refractory CC) or when no underlying disease or cause can be identified (unexplained CC). There are currently no recommendations in Switzerland outlining how general practitioners (GPs) should approach the management of CC. The aim of this study was to establish a consensus among physicians from various specialties in Switzerland regarding the assessment, treatment, and referral of CC patients.

This Delphi-based consensus study included two survey rounds (May-December 2023) evaluating 71 statements on the assessment of CC and referral pathways among a panel of GPs, pulmonologists, allergologists, gastroenterologists, and ear nose and throat (ENT) specialists with experience managing CC in Switzerland (N = 50). A 9-point scale was used to rate agreement with statements; consensus in agreement or disagreement was achieved when the median of responses fell within 7-9 or 1-3, respectively, less than one third voted outside these ranges, and the interquartile range (IQR) was <4. An interdisciplinary Scientific Committee with representatives from medical disciplines involved in managing CC led the study and provided the context for the referral pathways proposed.

Consensus was reached on 84.5% of statements. Agreement was reached on general considerations for CC, initial actions to be taken in primary care, including clinical evaluation, 'red flags' to identify, pathologies to investigate, treatments to consider, and referral route. Two schematics were produced outlining 1) how to perform a basic assessment of CC patients in primary care, and 2) how and when to refer patients to specialists if CC persists.

This study provides valuable recommendations for management of CC, promoting standardized assessment and referral of patients, which is not currently achieved in Switzerland.