ACCP on cough

The American College of Chest Physicians "uses the most rigorous and current methods to develop its evidence-based clinical practice guidelines, including those for cough," Richard Irwin, Chairman of ACCP's Cough Guidelines Committee, et al., state in a letter to The Lancet March 25. The group responds to a January editorial, which said ACCP cough treatment guidelines "may be a hollow exercise." ACCP said there was no evidence that OTC expectorants or suppressants relieve cough (1"The Tan Sheet" Jan. 16, 2006, p. 4). According to The Lancet, over half of the guidelines are "based more on opinion that on evidence," and one third are "based on 'low' evidence, yet backed with the second highest grade (B) of support." In response, Irwin et al. assert that the guide is "based on the best available evidence" and that when evidence was not robust, "the panel had to decide whether to do nothing or to offer some guidance to clinicians faced with patients in need of medical management." Where no published clinical trial results existed, panel members provided guidance and guidelines were graded with an "E" for "expert" in order to be "totally transparent," Irwin et al. say...