CICADA: Cough in Children and Adults: Diagnosis and Assessment. Australian Cough Guidelines summary statement

Raymond J Mullins, Constance H Katelaris and Janet Rimmer
Med J Aust 2010; 192 (11): . || doi: 10.5694/j.1326-5377.2010.tb03681.x
Published online: 7 June 2010

To the Editor: We read the article by Gibson and colleagues on the assessment and management of cough1 with some concern, specifically regarding the authors’ classification of levels of evidence for current therapies for allergic rhinitis. We would agree that a trial of antihistamines, intranasal corticosteroids and allergen immunotherapy is unlikely to help non-specific cough in the absence of allergic rhinitis. This consensus should be distinguished from the beneficial impact of these modalities on symptoms of allergic rhinitis, for which the authors misquote their main source of information2 and suggest that evidence of benefit from these is “weak”. Although evidence of benefit from allergen avoidance to help manage allergic respiratory disease is controversial,3 a large number of double-blind placebo-controlled trials of all other modalities show Level I evidence of benefit and category A strength of recommendation specifically for treatment of allergic rhinitis, as recently reviewed2,4-6 — evidence consistent with “strong” recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.7 We do our patients and colleagues a disservice to suggest otherwise.

  • Raymond J Mullins1
  • Constance H Katelaris2
  • Janet Rimmer3

  • 1 Health Sciences, University of Canberra, Canberra, ACT.
  • 2 Medical School, University of Western Sydney, Sydney, NSW.
  • 3 St Vincent’s Hospital, Sydney, NSW.

Competing interests:

Janet Rimmer has been on drug advisory boards for Novartis and GlaxoSmithKline and has received reimbursement for travel/accommodation expenses from Schering Plough. She has also received institutional support from Novatech, Novartis, GlaxoSmithKline and Schering Plough for clinical trials work. Constance Katelaris has been on drug advisory boards for GlaxoSmithKline and Nycomed and received reimbursement for travel/accommodation expenses.


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