Expert Panel Report Research Articles

Macrolides for Acute Wheezing Episodes in Preschool Children.

The National Asthma Education and Prevention Program's Expert Panel Report 3, Guidelines for the Diagnosis and Management of Asthma does not recommend antibiotics for the management of acute episodes of asthma exacerbation. Macrolides seem to have some potential effect beyond or in addition to their antibacterial effect. It has been reported that macrolides may potentially benefit patients with chronic inflammatory airway diseases due to their antibacterial, antiviral, and/or anti-inflammatory effects. This review presents recent data on use of azithromycin in prevention and management of acute exacerbation of respiratory symptoms in infants and young children.

Framing the Future: Exploring Inter-Professional Education and Practice in an Undergraduate Course

Framing the Future: Exploring Inter-Professional Education and Practice in an Undergraduate Course

Asthma control and need for future asthma controller therapy among inner-city Hispanic asthmatic children engaged in a pediatric asthma disease management program (the Breathmobile program, Mobile Asthma Care for Kids Network)

Objective: To determine whether significant numbers of asthmatic children with initially rated intermittent asthma later suffer poor asthma control and require the addition of controller medications. Methods: Inner-city Hispanic children were followed prospectively in an asthma-specific disease management system (Breathmobile) for a period of 2 years. Clinical asthma symptoms, morbidity treatment, and demographic data were collected at each visit. Treatment was based upon National Heart, Lung, and Blood Institute (NHLBI) Expert Panel Report 3 asthma guidelines. Primary outcome was percentage of patients with intermittent asthma who had not well or poorly controlled asthma during subsequent visits and required controller agents. Secondary outcomes were factors associated with the maintenance of asthma control. Results: About 30.9% of the patients with initial rating of intermittent asthma had not well controlled and poorly controlled asthma during subsequent visits and required the addition of controller agents. Factors associated with good asthma control were compliance, no previous emergency room visits and previous visit during spring season. Conclusion: Asthmatic children with intermittent asthma often lose asthma control and require controller therapy. This justifies asthma guideline recommendations to assess asthma control at follow-up visits and adjust therapy accordingly.

Metered-dose inhaler technique per the Global Initiative for Asthma and Expert Panel Report 3: Why do pharmaceutical companies have one critical difference?

Metered-dose inhaler technique per the Global Initiative for Asthma and Expert Panel Report 3: Why do pharmaceutical companies have one critical difference?

Minireview: Prognostic factors and the response to hydroxurea treatment in sickle cell disease.

This review describes current considerations in the use of hydroxyurea for the management of sickle cell disease in the context of clinical severity. Randomized trials of hydroxyurea have generally enrolled subjects with increased severity based on frequent vaso-occlusive events. An exception was the BABY HUG study in infants which documented substantial benefit even for asymptomatic subjects. Increasing data indicate that hydroxyurea has a substantial effect on reducing mortality in both adults and children-perhaps the most compelling reason for advocating the drug's widespread use. Although the efficacy of hydroxyurea is mediated primarily through increased erythrocyte fetal hemoglobin and much has been learned about the genomic influences on fetal hemoglobin levels in sickle cell disease, our ability to predict the fetal hemoglobin response to hydroxyurea remains limited; much more work in this area is indicated. The review is concluded with the recommendations of the 2014 NIH Evidence-Based Management of Sickle Cell Disease Expert Panel Report.

New VTE Guidelines Favor NOACs Over Warfarin

New VTE Guidelines Favor NOACs Over Warfarin

Automated Research Impact Assessment: A New Bibliometrics Approach.

As federal programs are held more accountable for their research investments, The National Institute of Environmental Health Sciences (NIEHS) has developed a new method to quantify the impact of our funded research on the scientific and broader communities. In this article we review traditional bibliometric analyses, address challenges associated with them, and describe a new bibliometric analysis method, the Automated Research Impact Assessment (ARIA). ARIA taps into a resource that has only rarely been used for bibliometric analyses: references cited in "important" research artifacts, such as policies, regulations, clinical guidelines, and expert panel reports. The approach includes new statistics that science managers can use to benchmark contributions to research by funding source. This new method provides the ability to conduct automated impact analyses of federal research that can be incorporated in program evaluations. We apply this method to several case studies to examine the impact of NIEHS funded research.

Provider Adherence to Evidence-Based Asthma Guidelines in a Community Health Center.

Background: Improved outcomes for patients with asthma have been proven with the use of the Expert Panel Report 3 (EPR-3) evidence-based asthma guidelines. These clinical guidelines are tools developed for providers to direct appropriate high-quality patient care that leads to positive outcomes. However, research has shown health care providers do not routinely follow the evidence-based asthma guidelines adequately. Objective: To develop and implement an evidence-based asthma protocol in a community clinic and improve provider adherence and attitudes/beliefs to the EPR-3 guidelines resulting in improved asthma outcomes, asthma control, and self-management for patients with asthma. Methods: The study was conducted in 2 parts over a period of 3 months. First, all medical providers at a community clinic were invited to participate in the research study. The intervention included implementing the asthma protocol within the current electronic health record (EHR). A pre- and postintervention questionnaire measuring provider's adherence and attitudes to evidence-based practice was administered. In addition, pre- and postclinic aggregate data for International Classification of Diseases codes specific to asthma that correlate to 7 identified aims based on the EPR-3 guidelines were collected. Results: Results show statistical significance among the provider attitudes/beliefs with the intervention, the greatest effect being found for the medical doctors. Four of the 7 aims showed improvement. Conclusions: The findings of this application research quality improvement study indicate that providing necessary tools and resources needed to adhere to evidence-based asthma guidelines can positively affect providers' adherence and attitudes/beliefs toward evidence-based guidelines.

Risk assessment of gene flow from genetically engineered virus resistant cassava to wild relatives in Africa: an expert panel report.

The probability and consequences of gene flow to wild relatives is typically considered in the environmental risk assessment of genetically engineered crops. This is a report from a discussion by a group of experts who used a problem formulation approach to consider existing information for risk assessment of gene flow from cassava (Manihot esculenta) genetically engineered for virus resistance to the 'wild' (naturalized) relative M. glaziovii in East Africa. Two environmental harms were considered in this case: (1) loss of genetic diversity in the germplasm pool, and (2) loss of valued species, ecosystem resources, or crop yield and quality due to weediness or invasiveness of wild relatives. Based on existing information, it was concluded that gene flow will occur, but it is not likely that this will reduce the genetic diversity in the germplasm pool. There is little existing information about the impact of the virus in natural populations that could be used to inform a prediction about whether virus resistance would lead to an increase in reproduction or survival, hence abundance of M. glaziovii. However, an increase in the abundance of M. glaziovii should be manageable, and would not necessarily lead to the identified environmental harms.

Reduction in the Frequency of Emergency Department Visits for Complications Related to Sickle Hemoglobinopathies: Effects of Aggressive Hydroxyurea Therapy

ContextEarly and aggressive use of hydroxyurea (HU) in sickle hemoglobinopathies has been in practice at our comprehensive sickle cell center since 2012 when standardized protocols were still evolving. The consensus treatment protocol for hydroxyurea therapy in sickle cell disease (SCD) documented in the "Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014" has authenticated our clinical practice.ObjectivesAlthough emergency departments play an important role in providing acute and urgent care for patients with SCD, the frequency of visits by patients can possibly be reduced by increased use of sickle-directed therapies in the outpatient setting. The objective of this study was to determine the impact of aggressive HU therapy, including shared decision making with parents for early use of HU and dose escalation up to the maximum tolerated dose, on the frequency of emergency department (ED) visits for patients with sickle hemoglobinopathies.MethodsED visits by patients with sickle hemoglobinopathies (HbSS disease, Hb S beta zero thalassemia, HbSC disease, Hb S beta plus thalassemia) were identified using ICD-9-CM diagnosis codes of 282.6, 282.60, 282.61, 282.62, 282.63, 282.64, 282.68, 282.69, 282.41, and 282.42. From visits having one or more of these diagnoses, cases that had indicated that the visit was related to an injury, poisoning, or adverse effect of medical treatment were excluded to form the study group of emergency department visits by patients. However, if the ED visit was for HU complications/side effects, they were included. Data from 2010-2015 was collected from the ED of Kosair Children's Hospital and affiliated hospitals in Louisville, which are the community-wide and primary locations where pediatric patients with sickle hemoglobinopathies are evaluated for disease-related complications requiring emergency management including pain crises, fever episodes, acute chest syndrome, etc.To determine if aggressive use of HU was associated with adecrease in the frequency of ED visits, segmented linear regression techniques were used to compare the mean monthly rates of ED visits before and after implementation of this treatment strategy.Results: The rate of sickle hemoglobinopathies seen in the ED significantly decreased after implementation of the aggressive HU treatment protocol (β=2.48 vs. β=-3.91, p=0.003). After implementation of the aggressive HU protocol, there has been a 55% decrease in the monthly rate of sickle hemoglobinopathies seen in the ED (21.0 vs. 9.5, p<0.001) from the peak monthly rate seen in 2012, which is a 40% reduction since the start of the study period [15.8 vs. 9.5, p=0.011]).Conclusion: Substantial reduction in the frequency of ED visits occurred in children with sickle hemoglobinopathies with the simple intervention of early and aggressive usage of HU and its dose escalation to the maximally tolerated dose. The findings of this study suggest that improving the process of prescribing HU as outlined in the "Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014" reduced the complications of sickle hemoglobinopathies requiring emergency care management and is an indicator of the enhanced quality of health care in sickle hemoglobinopathies. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Management of Osteonecrosis By Adult and Pediatric Sickle Cell Providers

Introduction:Osteonecrosis (ON) is a debilitating complication in 40% of adult sickle cell disease (SCD) patients. Almost all SCD ON will collapse, develop intractable pain or require surgery in 8 to 15 years from diagnosis. Majority of treatments have not been examined in a controlled setting, leading to variations in care, impeding research to verify the efficacy of existing therapies, and development of new treatments. The study's objective is to describe the screening, diagnostic and management patterns of ON in pediatric and adult SCD patients by US and Canadian providers.Materials and Methods:A cross-sectional survey of SCD providers from the Sickle Cell Adult Provider Network, the American Society of Pediatric Hematology/Oncology, and the Canadian Hemoglobinopathy Association was conducted from March to July 2015. The survey had 24 questions about provider demographics, characteristics of SCD population, ON diagnosis, staging and treatment. The survey was distributed electronically over 9 weeks with 2 reminders 3 weeks apart. Descriptive statistics were calculated and logistic regression was used to identify factors (specialty, location, years of practice, number of patients, adult vs. pediatric centers) that were associated with screening, diagnostic, staging and treatment approaches.Results:Of the 2,475 health care providers surveyed, 78 participants responded from 63 centers with 17,232 patients (17-23% of the estimated SCD population in US and Canada). Majority of respondents were located in urban teaching centers (93%). All (100%) respondents self-identified as SCD providers: 44 adult hematology/oncology (heme/onc) specialist; 3 internists; 24 pediatric heme/onc specialist; 5 nurse clinicians; 1 pharmacist; and 1 social worker. The median time in practice was 16 years (min 1, max 40). The estimated number of unique patients under the care of the respondents was 10,697, of which 1,946 (18%) had ON. More than half of the ON patients had joint collapse (n=1,050, 54%), and 72% had joint replacement. Only (13%) of the respondents screened for ON in asymptomatic patients, and screening measures include 50% by x-ray; 38% by physical, 12% by other modalities. All (100%) respondents screened for ON in symptomatic patients: 51% using x-ray and MRI, 41% x-ray, 7% MRI. The majority of respondents (72%) did not know the ON staging methods used. Frequencies of respondents using non-surgical and surgical treatments in pre-collapse and collapsed ON are shown in Table 1. Respondents' years in practice was the only factor significantly associated with the use of screening in asymptomatic SCD patients (OR 2.9/decade in practice, p=0.030). Respondents' years in practice was also associated with a reduced likelihood of hydorxyurea (HU) use in pre-collapse ON (OR 0.44/decade more in practice, p=0.011). Patients with collapsed ON under the care of pediatric heme/onc specialists were more likely to be treated with core decompression than adult heme/onc specialist or internist (OR 10.7, p=0.016).Discussion:Our survey suggests that the diagnosis, classification and management of ON is highly heterogeneous, despite the 2014 NIH expert panel report on the management of SCD prior to the distribution of the survey. The lower prevalence of ON in our study compared to that in cohort-wide screening may be due to the lack of screening by surveyed providers in asymptomatic SCD patients, suggesting ON may be underdiagnosed. Despite lack of evidence for their efficacy, HU and core decompression were used by majority of respondents in pre-collapse ON. A limitation of the study is difficulty in estimating the true response rate since the number of SCD providers in US and Canada is not known, potentially impacting the results' generalizability. The variations in practice and the high prevalence of collapsed joints requiring replacement in the surveyed population confirms the need to develop a uniformed approach in screening, diagnosis, and evidence-based therapies in SCD ON.Table 1Non-surgical and surgical treatments used by respondents in pre-collapse and collapsed ON. Some respondents selected multiple responsesTreatmentsNumber of Respondents (%)Non-surgicalPre-collapse (n=54)Collapsed (n=53)Analgesia53 (98%)52 (98%)Physiotherapy49 (91%)37 (70%)Hydroxyurea32 (59%)28 (53%)SurgicalPre-collapse (n=38)Collapsed (n=45)Core decompression33 (87%)10 (22%)Hip replacement9 (24%)43 (95%) DisclosuresOff Label Use: Hydroxyurea for treatment of osteonecrosis in sickle cell disease. Kuo:Novartis Canada: Honoraria, Other: Advisory Board; Alexion Pharmaceuticals: Honoraria, Other: Advisory Board.

Hydroxyurea Use in Children with Sickle Cell Disease: Do Severely Affected Patients Use It and Does It Impact Hospitalization Outcomes?

BackgroundThe2014 National Heart, Lung, and Blood Institute Expert Panel Report recommends that hydroxyurea (HU) be offered to all children with Hemoglobin SS and Sβ0 sickle cell disease (SCD) and that it be considered for children with Hemoglobin SC or Sβ+ who have clinically severe SCD. Describing current HU use among hospitalized children with SCD could identify whether HU is being prescribed to children who may benefit from it and whether HU improves hospitalization outcomes.ObjectivesThe primary aims of this study were to determine the current rate of HU use in hospitalized children and to determine if HU was differentially used in children with clinically severe SCD. Additionally, we examined if hospitalized HU users had improved hospitalization outcomes as measured by fewer deaths, shorter lengths of stay (LOS), fewer intensive care unit (ICU) admissions, and fewer erythrocyte transfusions compared to HU non-users.MethodsWe performed a retrospective analysis of the Pediatric Health Information System (PHIS) inpatient data, a dataset developed by the Children's Hospital Association. PHIS participating hospitals supply International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, de-identified demographic data, procedure codes, and charge codes for all of their hospitalization discharges. We included children ages 2-18 with SCD discharged between January 1, 2011-September 30, 2014 from the 42 hospitals that provided complete data to PHIS during the study period. Only patients' most recent hospitalization during the study period was analyzed to reflect the current rate of HU use. The following patient data within PHIS were obtained for all eligible discharges: age, gender, HU use, discharge status (dead, alive), ICU admission, asthma diagnosis, total number of ICD-9-CM diagnoses, LOS (days), erythrocyte transfusion, and insurance provider (private, public, unknown). Since the ICD-9-CM codes for patients' SCD genotype are not discreet, we did not use SCD genotype in our analyses. We defined patients as having clinically severe SCD if they had a history of a recent ICU admission (after 2009) or a history of ≥3 hospital admissions in the year preceding their most recent admission. This severity definition was selected because it is used in clinical practice or in clinical trials to identify children with severe SCD and because it could be captured within PHIS. Chi-squared and t-tests were used to compare the two groups, and since this was an observational study, propensity score weighting was used to balance differences in the baseline characteristics between HU users and non-users.ResultsWe identified 2,665 unique children with SCD. Approximately 80% had an inpatient code indicating HU use. The mean age of HU users was 11.1 years (SD ± 4.8), which was younger (p=0.013) than non-users (11.7 years SD ± 4.8). Two HU users and four non-users died during their hospitalization. Significantly more (p<0.001) non-users (30.1%) had a prior ICU admission compared to HU users (18.7%). More non-users (33.9%) also had a history of three or more admissions compared to HU users (21.5%) (p<0.001). HU use did not significantly differ (p=0.08) by public (81.2%), private (83%), or unknown (70.2%) insurance provider. After applying propensity score weighting to balance these differences, HU users' and non-users' LOS, prevalence of ICU admissions, and prevalence of erythrocyte transfusions during their most recent hospitalizations did not significantly differ.DiscussionOur study confirms that HU use is high among hospitalized children with SCD. However, we find that HU is not utilized by many children with clinically severe SCD, despite few other available therapies. Prior clinical trials show that HU use reduces hospitalizations, but our findings do not support that HU improves inpatient outcomes in those who are hospitalized. Our results support consideration of HU in children with SCD to prevent their hospitalization, rather than as a treatment to improve their hospitalization outcomes. Additional treatment options are needed for hospitalized children to reduce their LOS, ICU admissions, and erythrocyte transfusions. DisclosuresOff Label Use: Hydroxyurea is a FDA approved medication for adults with sickle cell disease but it is not currently approved for children. Hydroxyurea induces fetal hemoglobin production and results in reduced complications in patients with sickle cell disease. There are multiple clinical trials showing that it is safe and effective for children with sickle cell disease..

Asthma Control Assessment Tools.

Both the National Asthma Education and Prevention Program Expert Panel Report 3 and the 2015 Global Initiative for Asthma guidelines identify achieving and maintaining asthma control as goals of therapy, and they emphasize periodic assessment of asthma control once treatment is established. Accurate assessment of asthma control is difficult due to the complexity of asthma control and due to the limitations in the traditional methods of assessment, such as lung function tests, physician assessment, and patients' self-assessment. Relying solely on the role of lung function tests is insufficient to reflect the status of asthma control, since patients with asthma may have normal spirometry between exacerbations. Clinicians often overestimate the level of asthma control. Similarly, it is not uncommon for patients to overestimate how well their asthma is controlled, and, therefore, they under-report asthma symptoms and fail to recognize the impact that asthma has on their daily life. As a result, several tools have been developed to quantify the level of asthma control, identify patients at risk, and evaluate the effect of asthma management. This review examines the commonly used asthma control assessment tools in terms of content, psychometric properties, methods of administration, limitations, and ability to reflect the overall status of asthma control, which can aid clinicians in selecting the most appropriate tool for their needs.

The effectiveness of school-based family asthma educational programs on the quality of life and number of asthma exacerbations of children aged five to 18 years diagnosed with asthma: a systematic review protocol.

REVIEW QUESTION / OBJECTIVE The objective of this review is to identify the best available quantitative evidence related to the effectiveness of school-based family asthma educational programs on the quality of life and number of asthma exacerbations of children aged five to18 years with a diagnosis of asthma. INCLUSION CRITERIA Types of participants This review will consider studies that include children, five to 18 years of age, of any gender, race, or ethnicity with a clinical diagnosis of asthma, who has participated in school-based asthma education programs that include their caregivers. Studies that include children younger than age five and older than age 18, with respiratory diseases other than asthma, who have not participated in school-based asthma education programs that include their caregivers will be excluded. Types of intervention(s) This review will consider studies that evaluate the effectiveness of school-based family asthma education interventions on the quality of life and number of asthma exacerbations of children with asthma compared to absence of school-based family asthma education programs. Types of outcomes This review will consider studies that include the following outcome measures: primary outcomes of quality of life and asthma exacerbations, and secondary outcomes of absences from school or work, physical activity intolerance, and emergency hospital visits as a result of asthma exacerbations. Quality of life can be measured by a valid and reliable tool such as the Pediatric Asthma Quality of Life Questionnaire. The number of asthma exacerbations can be measured by valid and reliable tools such as the TRUNCATED AT 250 WORDS

Adult Bronchoscopy Training: Current State and Suggestions for the Future: CHEST Expert Panel Report

The determination of competency of trainees in programs performing bronchoscopy is quite variable. Some programs provide didactic lectures with hands-on supervision, other programs incorporate advanced simulation centers, whereas others have a checklist approach. Although no single method has been proven best, the variability alone suggests that outcomes are variable. Program directors and certifying bodies need guidance to create standards for training programs. Little well-developed literature on the topic exists. To provide credible and trustworthy guidance, rigorous methodology has been applied to create this bronchoscopy consensus training statement. All panelists were vetted and approved by the CHEST Guidelines Oversight Committee. Each topic group drafted questions in a PICO (population, intervention, comparator, outcome) format. MEDLINE data through PubMed and the Cochrane Library were systematically searched. Manual searches also supplemented the searches. All gathered references were screened for consideration based on inclusion criteria, and all statements were designated as an Ungraded Consensus-Based Statement. We suggest that professional societies move from a volume-based certification system to skill acquisition and knowledge-based competency assessment for trainees. Bronchoscopy training programs should incorporate multiple tools, including simulation. We suggest that ongoing quality and process improvement systems be introduced and that certifying agencies move from a volume-based certification system to skill acquisition and knowledge-based competency assessment for trainees. We also suggest that assessment of skill maintenance and improvement in practice be evaluated regularly with ongoing quality and process improvement systems after initial skill acquisition. The current methods used for bronchoscopy competency in training programs are variable. We suggest that professional societies and certifying agencies move from a volume- based certification system to a standardized skill acquisition and knowledge-based competency assessment for pulmonary and thoracic surgery trainees.

Introduction of time-based targets has improved the training environment for emergency medicine: No.

Introduction of time-based targets has improved the training environment for emergency medicine: No.

A review of adult asthma and the effectiveness of education programs in reducing symptoms

Asthma is a chronic inflammatory disease that occurs in children and adults. The National Heart, Lung, and Blood Institute (NHLBI) recommends asthma self-management education to be essential in providing patients with the skills necessary to control asthma and improve outcomes. A number of studies have been conducted to assess the effectiveness of these educational programs in children; however, such studies have not demonstrated efficacy in adult populations. This review explores the epidemiology of asthma, the different categories of asthma based on demographic differences, and environmental triggers of asthma. We also discuss common medical options that are available to treat asthma. We then describe the components of an asthma education program and the effectiveness in improving patient outcomes. The literature review was conducted using the National Library of Medicine Pub Med search engine. Comprehensive reviews were focused on the English literature involving human subjects in the last 5 years. Randomized controlled trials were selected for a citation on each subject when available. The Expert Panel Report 3 (EPR-3; Guidelines for the Diagnosis and Management of Asthma – Report 2007) was used as the primary reference source for standard of care treatment guidelines. Search terms included asthma, motivational interviewing, irritant-induced asthma, asthma education, home intervention, telemedicine, nitric oxide, asthma action plan, occupational asthma, IgE-mediated asthma, asthma guidelines, asthma prevalence, and asthma treatment.

A Multisite Evaluation of Pediatric Asthma-Related Treatment in Accordance to the 2007 National Heart, Lung and Blood Institute Expert Panel Report — 3 Guidelines

A Multisite Evaluation of Pediatric Asthma-Related Treatment in Accordance to the 2007 National Heart, Lung and Blood Institute Expert Panel Report — 3 Guidelines

Year in review: asthma

The Yellow Zone Practice Parameter reviewed the evidence for home interventions for patients when they lose asthma control and enter the yellow zone in the “traffic light” model of asthma action plans.1 As pointed out in the parameter, patients often adjust their medications (with or without the advice of their physician) when faced with loss of control but, unfortunately, often do so inappropriately. The hope of the parameter is to offer evidence-based recommendations for patient-directed treatment changes. It is meant to create a partnership between the provider and the patient, empower patients to manage their asthma symptoms, and prevent patients from entering the red zone. Strong recommendations in the parameter include instructing patients to activate the yellow zone intervention plan early on when there is acute loss of asthma control and/or at the onset of an upper respiratory infection if this is a known trigger. Beyond the recommendationsmade in the Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma of a short-acting b-agonist use in the yellow zone, the practice parameter poses other treatments as options, including symptom-driven use of an inhaled corticosteroid (ICS) with a concomitant b-agonist. The approach relies on “dynamic dosing,” which is the use of ICS with a reliever or “adjustable

Tools for Assessing Outcomes in Studies of Chronic Cough: CHEST Guideline and Expert Panel Report

Since the publication of the 2006 American College of Chest Physicians (CHEST) cough guidelines, a variety of tools has been developed or further refined for assessing cough. The purpose of the present committee was to evaluate instruments used by investigators performing clinical research on chronic cough. The specific aims were to (1) assess the performance of tools designed to measure cough frequency, severity, and impact in adults, adolescents, and children with chronic cough and (2) make recommendations or suggestions related to these findings. By following the CHEST methodologic guidelines, the CHEST Expert Cough Panel based its recommendations and suggestions on a recently published comparative effectiveness review commissioned by the US Agency for Healthcare Research and Quality, a corresponding summary published in CHEST, and an updated systematic review through November 2013. Recommendations or suggestions based on these data were discussed, graded, and voted on during a meeting of the Expert Cough Panel. We recommend for adults, adolescents (≥ 14 years of age), and children complaining of chronic cough that validated and reliable health-related quality-of-life (QoL) questionnaires be used as the measurement of choice to assess the impact of cough, such as the Leicester Cough Questionnaire and the Cough-Specific Quality-of-Life Questionnaire in adult and adolescent patients and the Parent Cough-Specific Quality of Life Questionnaire in children. We recommend acoustic cough counting to assess cough frequency but not cough severity. Limited data exist regarding the performance of visual analog scales, numeric rating scales, and tussigenic challenges. Validated and reliable cough-specific health-related QoL questionnaires are recommended as the measurement of choice to assess the impact of cough on patients. How they compare is yet to be determined. When used, the reporting of cough severity by visual analog or numeric rating scales should be standardized. Previously validated QoL questionnaires or other cough assessments should not be modified unless the new version has been shown to be reliable and valid. Finally, in research settings, tussigenic challenges play a role in understanding mechanisms of cough.