title: Occupational and Environmental Contributions to Chronic Cough in Adults: Chest Expert Panel Report.
abstract: 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.
authors: Division of Respiratory Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada. Electronic address: susan.tarlo@utoronto.ca.
authors: Susan M
authors: SM
authors: Tarlo
authors: Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, TX.
authors: Kenneth W
authors: KW
authors: Altman
authors: Division of Allergy and Immunology, University of Medicine and Dentistry of New Jersey-Rutgers University, Newark, NJ.
authors: John
authors: J
authors: Oppenheimer
authors: Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Mayo College of Medicine, Rochester, MN.
authors: Kaiser
authors: K
authors: Lim
authors: John Hunter Hospital, New South Wales, Australia.
authors: Anne
authors: A
authors: Vertigan
authors: Fire Department of the City of New York, Brooklyn, NY.
authors: David
authors: D
authors: Prezant
authors: Division of Pulmonary, Allergy and Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA.
authors: Richard S
authors: RS
authors: Irwin
mesh_terms: D000328:Adult; D059366:Asthma, Occupational / Q000175:diagnosis* / Q000453:epidemiology; D002908:Chronic Disease; D003371:Cough / Q000453:epidemiology*; D003697:Delphi Technique; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology; D008385:Marijuana Smoking / Q000453:epidemiology; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D012698:Serologic Tests; D012882:Skin Tests; D012907:Smoking / Q000453:epidemiology
keywords: allergy; cough; environmental; occupational; smoking