Assessment of Intervention Fidelity and Recommendations for Researchers Conducting Studies on the Diagnosis and Treatment of Chronic Cough in the Adult

Abstract

Only low-quality evidence supports that intervention fidelity strategies were used when conducting primary research in diagnosing and managing chronic cough in adults. This supports the contention that some of the variability in the reporting of patients with unexplained or unresolved chronic cough may be due to lack of intervention fidelity. By following the recommendations and suggestions in this article, researchers will likely be better able to incorporate strategies to address intervention fidelity, thereby strengthening the validity and generalizability of their results that provide the basis for the development of trustworthy guidelines.

Treatment of Unexplained Chronic Cough

“…These processes are detailed in the CHEST chronic cough guideline, 2 as well as in other cough reviews. 4,5 The completeness of this assessment and treatment approach according to the five areas of intervention fidelity (study design, training of providers, delivery of treatment, receipt, and enactment of treatment) 41 is recognized as an important paradigm in the determination of UCC. Although the studies reviewed in this assessment showed fair to good adherence to intervention fidelity, there are clearly opportunities to provide better documentation of the assessment process in published reports.…”

“…There is also a need to consistently use validated outcome assessment tools when evaluating treatment response in chronic cough. Current CHEST guidelines directed at strengthening future studies of cough provide recommendations for incorporating the use of an intervention manual and other intervention fidelity strategies in chronic cough studies 41 and also detail validated tools developed for assessing cough outcomes. 42 The use of an intervention fidelity tool will facilitate the strengthening of study quality in chronic cough research.…”

“…42 The use of an intervention fidelity tool will facilitate the strengthening of study quality in chronic cough research. 41 Intervention fidelity bias was identified as a problem in studies of ICS for unexplained chronic cough; these studies included incomplete assessments of asthma, allergy, and nonasthmatic eosinophilic bronchitis. Specifically, this means that if a protocol-based clinical trial of ICS yielded no improvement (suggesting there was no airway inflammatory process as the basis for the cough and thus substantiating that the cough was an UCC), the recommendation is not to treat with ICS.…”

Management of chronic refractory cough

“…A guideline based chronic cough assessment is an essential part of the investigation of these patients. 64 66 Once this has been completed and the results reviewed, if the cough persists then the patient can be diagnosed as having chronic refractory cough.…”

Tuberculosis among COPD Patients in Guba City, Azerbaijan

“…Thus, COPD can be para-, meta-, and post-tuberculosis process [1]- [4]. Both diseases have similar risk factors: smoking, low socio-economic status of the individual and the violation of the immune defense [5]- [7]. A related aspect of the above pathogenetic nosology is the development of destructive changes in the pulmonary parenchyma, caused, in particular, a metabolic disorder due to exposure to tobacco metalloproteinases or virulence factors Mycobacterium tuberculosis [2] [5] [8].…”