Cough in Children and Adults: Diagnosis, Assessment and Management (CICADA). Summary of an updated position statement on chronic cough in Australia.

INTRODUCTION: Cough is the most common symptom leading to medical consultation. Chronic cough results in significant health care costs, impairs quality of life, and may indicate the presence of a serious underlying condition. Here, we present a summary of an updated position statement on cough management in the clinical consultation. MAIN RECOMMENDATIONS: Assessment of children and adults requires a focused history of chronic cough to identify any red flag cough pointers that may indicate an underlying disease. Further assessment with examination should include a chest x-ray and spirometry (when age > 6 years). Separate paediatric and adult diagnostic management algorithms should be followed. Management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns. First Nations adults and children should be considered a high risk group. The full statement from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia for managing chronic cough is available at https://lungfoundation.com.au/resources/cicada-full-position-statement. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: Algorithms for assessment and diagnosis of adult and paediatric chronic cough are recommended. High quality evidence supports the use of child-specific chronic cough management algorithms to improve clinical outcomes, but none exist in adults. Red flags that indicate serious underlying conditions requiring investigation or referral should be identified. Early and effective treatment of chronic wet/productive cough in children is critical. Culturally specific strategies for facilitating the management of chronic cough in First Nations populations should be adopted. If the chronic cough does not resolve or is unexplained, the patient should be referred to a respiratory specialist or cough clinic.

A review of general pain measurement tools and instruments for consideration of use in COPD clinical practice.

BACKGROUND: The experience of pain can have a significant impact on the everyday life of individuals including those with COPD. Recently, pain has emerged as an area in COPD research. When considering pain measurement in COPD studies, it is important to consider the validity, reliability, responsiveness and interpretability of instruments and tools. This review sought to assess these domains of general pain instruments and tools using the consensus-based standards for the selection of health measurement instruments (COSMIN). METHODS: Three separate analyses were used to assess general pain measurement tools and instruments. These comprise COSMIN's, 1) methodological quality assessment with dichotomous responses, 2) the 4-point rating scale, and 3) overall quality criteria using an assessment scale for clinimetric properties by Terwee. RESULTS: Overall Pain Sensitivity Questionnaire (PSQ) was found to have the highest rating in all domains of validity, reliability, responsiveness and interpretability. In the first analysis, PSQ and Geriatric Pain Measure (GPM) scored highest in four of the six domains. In the second analysis, using the 4-point rating, the PSQ scored highest in three of four domains. In the third analysis, the GPM scored the highest in all four domains. Overall the PSQ, GPM and Defense and Veterans Pain Rating Scale scores were consistently high in the three separate analyses in this review. CONCLUSION: This review found variability in the domains of validity, reliability, responsiveness and interpretability in general pain tools and instruments. The PSQ was found to be the most valid and reliable general pain measurement instrument for adult populations.