Occupational and Environmental Contributions to Chronic Cough in Adults: Chest Expert Panel Report

Susan M. Tarlo, Kenneth W. Altman, John Oppenheimer, Kaiser Lim, Anne E. Vertigan, David Prezant, Richard S. Irwin, Todd M. Adams, Kenneth W. Altman, Elie Azoulay, Alan F. Barker, Surinder S. Birring, Fiona Blackhall, Donald C. Bolser, Louis Philippe Boulet, Sidney S. Braman, Christopher Brightling, Priscilla Callahan-Lyon, Anne B. Chang, Satoru EbiharaAli A. El Solh, Patricio Escalante, Anthony Feinstein, Stephen K. Field, Dina Fisher, Cynthia T. French, Peter Gibson, Philip Gold, Michael K. Gould, Cameron Grant, Susan M. Harding, Anthony Harnden, Adam T. Hill, Richard S. Irwin, Peter J. Kahrilas, Karina A. Keogh, Kefang Lai, Andrew P. Lane, Kaiser Lim, Mark A. Malesker, Stuart Mazzone, Lorcan McGarvey, Alex Molasiotis, M. Hassan Murad, John Oppenheimer, David Prezant, Marcos I. Restrepo, Mark Rosen, Bruce Rubin, Jay H. Ryu, Susan M. Tarlo, Anne E. Vertigan, Gang Wang, Miles Weinberger, Kelly Weir

Research output: Journal article publicationJournal articleAcademic researchpeer-review

18 Citations (Scopus)


Background In response to occupational and environmental exposures, cough can be an isolated symptom reflecting exposure to an irritant with little physiological consequence, or it can be a manifestation of more significant disease. This document reviews occupational and environmental contributions to chronic cough in adults, focusing on aspects not previously covered in the 2006 ACCP Cough Guideline or our more recent systematic review, and suggests an approach to investigation of these factors when suspected. Methods MEDLINE and TOXLINE literature searches were supplemented by articles identified by the cough panel occupational and environmental subgroup members, to identify occupational and environmental aspects of chronic cough not previously covered in the 2006 ACCP Cough Guideline. Based on the literature reviews and the Delphi methodology, the cough panel occupational and environmental subgroup developed guideline suggestions that were approved after review and voting by the full cough panel. Results The literature review identified relevant articles regarding: mechanisms; allergic environmental causes; chronic cough and the recreational and involuntary inhalation of tobacco and marijuana smoke; nonallergic environmental triggers; laryngeal syndromes; and occupational diseases and exposures. Consensus-based statements were developed for the approach to diagnosis due to a lack of strong evidence from published literature. Conclusions Despite increased understanding of cough related to occupational and environmental triggers, there remains a gap between the recommended assessment of occupational and environmental causes of cough and the reported systematic assessment of these factors. There is a need for further documentation of occupational and environmental causes of cough in the future.

Original languageEnglish
Pages (from-to)894-907
Number of pages14
Issue number4
Publication statusPublished - 1 Oct 2016


  • allergy
  • cough
  • environmental
  • occupational
  • smoking

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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