Astmamedicatie

Publicatiedatum: 08-06-2026

Beoordeeld op geldigheid: 08-06-2026

Uitgangsvraag

Wat is de aanbevolen strategie voor het toepassen van astmamedicatie bij de behandeling van volwassen patiënten met chronische hoest?

Aanbeveling

Beslis samen met de patiënt met chronische hoest of een (proef)behandeling met astmamedicatie ingezet wordt. Bespreek de onzekerheden van het wetenschappelijke bewijs voor de effectiviteit van astmamedicatie bij patiënten met chronische hoesten. Bespreek tevens de voordelen (potentieel vermindering van hoestklachten na een aantal weken) en nadelen om samen tot een goed onderbouwde keuze voor de behandeling te komen (shared decision making).

Start bij voorkeur met inhalatiemedicatie met anti-inflammatoire werking (ICS, eventueel in combinatie met een bronchusverwijder).
Kies samen met de patiënt op basis van individuele factoren uit de verschillende beschikbare medicamenten. Hiervoor verwijzen we naar een eigen regionaal formularium.
Zorg voor duidelijke en beschikbare instructies over inhalatietechniek.

Informeer de patiënt over onaanvaardbare bijwerkingen en stoppen van de medicatie bij deze bijwerkingen of bij uitblijven van effect na 4-8 weken na adequaat gebruik en inhalatietechniek. In het geval van effect kan samen beslist worden of afbouwen van astmamedicatie wenselijk is.

Overwegingen

Balans tussen gewenste en ongewenste effecten

Leukotriëenreceptorantagonisten (LTRA)

Voor de cruciale uitkomstmaat ‘verbetering van kwaliteit van leven’ voor patiënten met hoestvariant astma lijkt er een klein, niet-klinisch relevant effect te zijn in het voordeel van leukotriëenreceptorantagonisten (LTRA) met een odds ratio van 2,64 (CI 95% 0,97 - 7,23). Dit is echter op basis van één studie en de bewijskracht is laag door een kleine populatie, weinig events en een breed betrouwbaarheidsinterval. Dezelfde studie rapporteert voor de uitkomstmaat ‘hoestfrequentie’ een mogelijk effect in het voordeel van LTRA maar de bewijskracht hiervan is laag. Voor uitkomstmaat ‘ernst hoesten’ zijn geen studies gevonden.

Bronchusverwijders

Voor de cruciale uitkomstmaat ‘verbetering van kwaliteit van leven’ werd geen duidelijk effect gevonden voor het gebruik van bronchusverwijders versus placebo. Fukumitsu (2023) laat een niet-klinisch relevant effect zien van 1,30 (95%CI -0,58, 3,18) na 4 weken bij patiënten met chronische hoest en astma waarbij de bewijskracht laag was. Chalverley (2003) vond geen klinisch relevant verschil (op een andere schaal) met -2,70 (95%CI -5,08, 0,32) na 52 weken bij patiënten met chronische hoest waarbij de bewijskracht matig was. ‘Ernst hoesten’ na 4 en na 52 weken liet geen klinisch relevant verschil zien. Voor de uitkomstmaat ‘hoestfrequentie’ werden geen studies gevonden.

Inhalatiecorticosteroïden (ICS)

Voor de cruciale uitkomstmaat ‘verbetering van kwaliteit van leven’ voor patiënten met chronische hoest lijkt er weinig tot geen verschil te zijn tussen inhalatiecorticosteroïden (ICS) en placebo met een gemiddeld verschil van -0,40 (95%CI -3,03, 2,23). Hiervoor is echter maar één klinische studie beschikbaar en de bewijskracht hiervan is zeer laag door de kleine populatie. Voor ‘ernst hoesten’ zijn er geen klinisch relevante verschillende gevonden na 8 weken bij patiënten met chronische hoest en de bewijskracht hiervan is zeer laag. Voor ‘hoestfrequentie’ zijn geen studies gevonden.

Bronchusverwijders en ICS

Voor de cruciale uitkomstmaat ‘verbetering van kwaliteit van leven’ bij patiënten met chronische hoest en COPD is er geen duidelijk effect voor gebruik van bronchusverwijders en ICS versus placebo met een MD van -2,20 (95%CI -4,55, 0,15) na 52 weken met een matige bewijskracht. Voor ‘ernst van hoest’ zijn er ook geen klinisch relevante verschillen gevonden. De uitkomstmaat ‘hoestfrequentie’ is in geen van de studies meegenomen.

Kwaliteit van bewijs

De studies die geïncludeerd zijn, hebben heterogene populaties, waarbij in sommige studies expliciet is benoemd dat bijvoorbeeld COPD-patiënten zijn geëxcludeerd, terwijl andere studies deze patiënten wel includeerden. Er werden daarnaast verschillende schalen van de uitkomstmaten gebruikt en follow-ups verschilden tussen 4 week en 52 weken.

LTRA

De overall kwaliteit van bewijs is laag. Dit betekent dat we onzeker zijn over het gevonden geschatte effect van de cruciale uitkomstmaten.

Er is afgewaardeerd vanwege zeer ernstige imprecisie: onnauwkeurigheid (vanwege een zeer klein aantal events bij een kleine steekproefgrootte).

Bronchusverwijders

De overall kwaliteit van bewijs is laag. Dit betekent dat we onzeker zijn over het gevonden geschatte effect van de cruciale uitkomstmaten.

Er is afgewaardeerd vanwege risk of bias (onvoldoende blindering) en ernstige imprecisie (onnauwkeurigheid, brede betrouwbaarheidsintervallen).

ICS

De overall kwaliteit van bewijs is zeer laag. Dit betekent dat we zeer onzeker zijn over het gevonden geschatte effect van de cruciale uitkomstmaten.

Er is afgewaardeerd vanwege risk of bias (eerder stoppen van de studie dan gepland), inconsistentie, indirect bewijs en ernstige imprecisie (onnauwkeurigheid vanwege het niet bereiken van de optimale steekproefgrootte).

Bronchusverwijders en ICS

De overall kwaliteit van bewijs is redelijk. Dit betekent dat we redelijk zeker zijn over het gevonden geschatte effect van de cruciale uitkomstmaten.

Er is afgewaardeerd vanwege imprecisie: onnauwkeurigheid (studieduur).

Waarden en voorkeuren van patiënten (en eventueel hun naasten/verzorgers)

Het voorspellen van het effect en de potentiële bijwerkingen op individueel niveau is lastig. Iedere patiënt maakt een persoonlijke afweging of eventuele bijwerkingen opwegen tegen het effect. Het is belangrijk dat de aanpak samen met de patiënt beslist wordt. Zo kan het bijvoorbeeld per persoon verschillen of een poederinhalator goed wordt verdragen of niet.

LTRA

Door remming van bronchoconstrictie kan hoestintensiteit afnemen. LTRA hebben een gunstig bijwerkingenprofiel. Milde, reversibele bijwerkingen zijn beschreven zoals hoofdpijn en lichte gastro-intestinale klachten. Medicatie is makkelijk in gebruik.

Bronchusverwijders

Bronchusverwijders zorgen voor afname van bronchoconstrictie en worden over het algemeen goed verdragen. Meest gemelde bijwerkingen zijn klachten van tachycardie.

Een goede inhalatietechniek is cruciaal.

ICS

Inhalatie met anti-inflammatoire medicatie (bij voorkeur ciclesonide) wordt over het algemeen goed verdragen. Gemelde bijwerkingen betreffen onder andere heesheid en orofaryngeale schimmelinfecties. Bij hoge doseringen kunnen systemische effecten optreden. Ook hier geldt dat een goede inhalatietechniek cruciaal is.

Kostenaspecten

Er zal geen verandering in kosten zijn, omdat de beschreven middelen in de praktijk al ingezet worden. Een inadequaat behandelde patiënt kan leiden tot meer zorggebruik en hogere zorgkosten vanwege secundaire effecten (uitval op werk, depressiviteit, sociale impact, urineverlies).

Gelijkheid ((health) equity/equitable)

Het is niet te verwachten dat de interventies leiden tot verschil in gezondheidsgelijkheid.

Aanvaardbaarheid:

Ethische aanvaardbaarheid

Er zullen geen problemen zijn met aanvaardbaarheid, haalbaarheid en implementatie, omdat de beschreven middelen in de praktijk al ingezet worden. Patiënten die een poederinhalator gebruiken kunnen wellicht meer last ervaren ten opzichte van het gebruik van dosisaerosol.

Duurzaamheid

Bij het gebruik van dosis-aerosolen komen fluorkoolwaterstoffen (HFK’s) vrij. Deze uitstoot draagt bij aan klimaatverandering. Door te kiezen voor een ander type inhalator, een poederinhalator, kunnen we de uitstoot van HFK’s verminderen. Poederinhalatoren kunnen helaas ook toename van hoesten geven. Belangrijk is om te staken met therapie wanneer er geen effect van is na minimaal 4 tot 8 weken adequaat gebruik.

Haalbaarheid

De interventie lijkt haalbaar. De interventie is over het algemeen al standaardzorg in de praktijk.

Rationale van de aanbeveling: weging van argumenten voor en tegen de interventies

Gezien het lage tot zeer lage bewijs voor elk medicament (LTRA, bronchusverwijders, ICS) afzonderlijk, wordt er een overkoepelende rationale en aanbeveling gegeven.

Astmamedicatie kan theoretisch door vermindering van bronchoconstrictie en/of anti-inflammatoire eigenschappen klachten van chronische hoest verminderen. Het bewijs van het mogelijke effect van astmamedicatie op chronisch hoesten (bij mensen met of zonder de diagnose astma/COPD en/of eosinofiele inflammatie) is echter laag door gebrek aan studies en wisselende kwaliteit van de studies. Het voorspellen van potentiële bijwerkingen op individueel niveau is lastig. Een eventuele proefbehandeling kan overwogen worden. Het is belangrijk om samen met de patiënt te beslissen of eventuele bijwerkingen opwegen tegen het effect bij patiënten met chronische hoest.

Eindoordeel:

Zwakke aanbeveling voor het gebruik van astmamedicatie bij chronisch hoesten.

Onderbouwing

Introduction

Asthmatic cough or eosinophilic airway inflammation is a known phenotype of chronic cough and a known treatable ‘trait’ (often described as: cough-variant asthma and eosinophilic bronchitis). A clearly defined strategy for (empirically) applying asthma medication in adult patients with chronic cough (who do or do not have a diagnosis of asthma or eosinophilic airway inflammation) is desirable.

Summary of Findings table: Leukotriene receptor antagonists (LTRA) compared to placebo for chronic cough (data cited from ERS guideline)
Population: Adult patients with chronic cough

Intervention: Anti-asthmatic drugs (LTRA)

Comparator: Placebo or other treatments

Outcome Timeframe	Study results and measurements	Absolute effect estimates		Certainty of the evidence (Quality of evidence)	Summary
		Placebo or other treatments	Anti-asthmatic drugs (LTRA)
Improvement in Quality of Life 4 weeks*	Odds ratio: 2.64 (CI 95% 0.97 - 7.23) Based on data from 14 participants in 1 study Follow up 4 weeks	333 Per 1000	569 Per 1000	Low Due to very serious risk of imprecision¹	LTRA may result in an increase in improved quality of life after 4 weeks when compared to placebo in patients with cough-variant asthma. (Spector, 2004)
		Difference: 236 more per 1000 (CI 95% 7 fewer - 450 more)
Cough frequency 4 weeks*	Measured by: audio cough meter Scale: - Based on data from 14 participants in 1 study Follow up 4 weeks	Mean change in number of coughs per day -	Mean change in number of coughs per day -	Low Due to serious imprecision²	LTRA may result in improved number of coughs per day after 4 weeks when compared to placebo in patients with cough-variant asthma. (Spector, 2004)
		Difference: MD 144.06 lower (CI 95% 219.39 lower - 68.73 lower)
Cough severity				No evidence was found	No evidence was found regarding the effect of LTRA on cough severity when compared with placebo in patients with chronic cough

*Data cited from ERS guideline

Imprecision: very serious. Low number of patients and no events in both groups;
Imprecision: serious. Low number of patients.

References
[1] Spector SL, Tan RA. Effectiveness of montelukast in the treatment of cough variant asthma. Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology. 2004;93(3):232-236.

Summary of Findings table: bronchodilators compared to placebo for chronic cough (data cited from ERS guideline)

Population: Adult patients with chronic cough

Intervention: Anti-asthmatic drugs (bronchodilators)

Comparator: Placebo or other treatments

Outcome

Timeframe

Study results and measurements

Absolute effect estimates

Certainty of the evidence

(Quality of evidence)

Summary

Placebo or other treatments

Anti-asthmatic drugs

(bronchodilators)

Quality of Life

52 weeks*

Measured by: SGRQ.
Scale: 0-100 lower better

Based on data from 733 participants in 1 study

Follow up 52 weeks

One study (Calverley, 2003) reported Quality of Life using the St. George's Respiratory Questionnaire (SGRQ). Mean difference was -2,70 (95%CI -5,08, 0,32)

Moderate

Due to serious imprecision¹

Use of bronchodilators likely result in little to no difference in SGRQ score after 52 weeks when compared to placebo in patients with chronic cough
(Calverley, 2003)

Quality of Life

4 weeks

Measured by: J-LCQ
Scale: 19 items higher better
Based on data from 48 participants in 1 study

Follow up 4 weeks

One study (Fukumitsu, 2023) reported Quality of Life using the Japanese- Leicester Cough Questionnaire (J-LCQ). Mean difference was 1.30 (95%CI -0.58, 3.18)

Low

Due to serious risk of bias, due to serious imprecision²

Bronchodilators may improve quality of life (J-LCQ score) after 4 weeks when compared to placebo in patients with chronic cough and asthma.

(Fukumitsu, 2023)

Cough severity

at 52 weeks*

Measured by: Patient completed score

Scale: 0 - 3 Lower better

Based on data from 733 participants in 1 study

Follow up 52 weeks

Mean cough score
-

Moderate

Due to serious imprecision³

Use of bronchodilators likely result in little to no difference in patient completed score after 52 weeks when compared to placebo in patients with chronic cough and COPD.
(Calverley, 2003)

Difference: MD 0.08 lower

(CI 95% 0.16 lower - 0.00 higher)

Cough severity

at 4 weeks

Measured by: VAS

Scale: 0 - 100 Lower better

Based on data from 58 participants in 1 study

Follow up 4 weeks

Mean (mm)
40.9

Mean (mm)
31.7

Low

Due to serious risk of bias, due to serious risk of imprecision⁴

The evidence suggests that bronchodilators may not reduce cough severity (measured on VAS) after 4 weeks when compared to placebo in patients with chronic cough and asthma.
(Fukumitsu, 2023)

Difference: MD 9.20 lower

(CI 95% 20.38 lower - 1.98 higher)

Cough frequency

No evidence was found

No evidence was found regarding the effect of bronchodilators on cough frequency when compared with placebo in patients with chronic cough

*Data cited from ERS guideline

Imprecision: serious. Wide confidence intervals;
Risk of Bias: serious. Insufficient blinding/missing outcome measures, possibly leading to detection bias. Insufficient blinding of participants and researchers. Imprecision: serious. Low sample size (<100);
Imprecision: serious. 95% CI was consistent with the possibility of improving and the possibility of worsening symptoms or no effect;
Risk of Bias: serious. Insufficient blinding of participants and researchers; Imprecision: serious. Wide confidence intervals.

References

[1] Calverley P, Pauwels R, Vestbo J, et al. Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: a randomised controlled trial. Lancet (London, England). 2003;361(9356):449-456.
[2] Fukumitsu K, Kanemitsu Y, Kurokawa R, Takeda N, Tajiri T, Nishiyama H, Ito K, Inoue Y, Yamamoto S, Mori Y, Fukuda S, Uemura T, Ohkubo H, Maeno K, Ito Y, Oguri T, Takemura M, Niimi A. Tiotropium for refractory cough in asthma via cough reflex sensitivity: A randomized, parallel, open-label trial. Ann Allergy Asthma Immunol. 2023 Jul;131(1):59-68.e3. doi: 10.1016/j.anai.2023.03.032. Epub 2023 Apr 7. PMID: 37030486.

Summary of Findings table: Inhaled corticosteroids (ICS) compared to placebo for chronic cough (data cited from ERS guideline)

Population: Adult patients with chronic cough

Intervention: Anti-asthmatic drugs (ICS)

Comparator: Placebo or other treatments

Outcome

Timeframe

Study results and measurements

Absolute effect estimates

Certainty of the evidence

(Quality of evidence)

Summary

Placebo or other treatments

ICS

Quality of Life

at 3 months

Measured by: LCQ
Scale: 19 items higher better

Based on data from 34 participants in 1 study

Follow up 3 months

One study (Van der Veer, 2023) reported Quality of Life using the Leicester Cough Questionnaire at 1 and three months. Mean difference after three months was -0.40 (95%CI -3.03 to 2.23)

Very low

Due to serious risk of bias, due to very serious imprecision¹

The evidence is very uncertain about the effect of ICS on LCQ scores after 3 months when compared with placebo in patients with chronic cough

(Van der Veer, 2023)

Cough severity

8 weeks*

Measured by cough symptom score

Scale: 0 - 10 Lower better

Based on data from 232 participants in 3 studies

Follow up 8 weeks

mean cough symptom score
-

Very low

Due to serious risk of bias, due to serious inconsistency, due to serious indirectness, due to serious imprecision²

The evidence is very uncertain about the effect of ICS on cough severity after 8 weeks when compared with placebo in patients with chronic cough
(Boulet, 1994; Ribeiro, 2007; Rytila, 2008)

Difference: SMD 0.28 lower

(CI 95% 0.79 lower - 0.23 higher)

Cough frequency

No evidence was found

No evidence was found regarding the effect of ICS on cough frequency when compared with placebo in patients with chronic cough

*data cited from ERS guideline

Risk of Bias: serious. Studies are terminated earliers resulting in possible overstimation of (positive) results. Imprecision: very serious. Low sample size (<100);
Risk of Bias: serious. Selective outcome reporting. Inconsistency: serious. High statistical heiterogeneity (I^2) of >60%. Indirectness: serious. Differences between target populatien and included. Imprecision: serious. Wide confidence intervals.

References

[1] van der Veer T, de Koning Gans JM, Braunstahl GJ, Pieters ALP, van den Berg JMW, Hoek RAS, Kamphuis LSJ, Bakker M, Dubois AVF, Aerts JGJV, van der Eerden MM. The effect of beclomethasone-formoterol versus placebo on chronic cough in patients with non-CF bronchiectasis: the FORZA randomised controlled trial. Eur Respir J. 2023 Jun 29;61(6):2300186. doi: 10.1183/13993003.00186-2023. PMID: 37263749.

[2] Boulet LP, Milot J, Boutet M, St Georges F, Laviolette M. Airway inflammation in no asthmatic subjects with chronic cough. American journal of respiratory and critical care medicine. 1994;149(2 Pt 1):482-489.

[3] Ribeiro M, Pereira CA, Nery LE, Beppu OS, Silva CO. High-dose inhaled beclomethasone treatment in patients with chronic cough: a randomized placebo-controlled study. Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology. 2007;99(1):61-68. 3.

[4] Rytila P, Ghaly L, Varghese S, Chung W, Selroos O, Haahtela T. Treatment with inhaled steroids in patients with symptoms suggestive of asthma but with normal lung function. The European respiratory journal. 2008;32(4):989-996.

Summary of Findings table: bronchodilators and inhaled corticosteroids (ICS) compared to placebo for chronic cough

Population: Adult patients with chronic cough

Intervention: Anti-asthmatic drugs (bronchodilators and ICS)

Comparator: Placebo or other treatments

Outcome

Timeframe

Study results and measurements

Absolute effect estimates

Certainty of the evidence

(Quality of evidence)

Summary

Placebo or other treatments

Bronchodilators and ICS

Quality of Life

52 weeks*

Measured by: SGRQ.
Scale: 0-100 lower better

Based on data from 719 participants in 1 study

Follow up 52 weeks

One study (Calverley, 2003) reported Quality of Life using the St. George's Respiratory Questionnaire (SGRQ). Mean difference was -2.20 (95%CI -4.55 to 0.15)

Moderate

Due to serious imprecision¹

Use of bronchodilators and ICS likely results in little to no difference in Quality of Life after 52 weeks when compared to placebo in patients with chronic cough and COPD.
(Calverley, 2003)

Cough severity

52 weeks*

Measured by: Patient completed daily score

Scale: 0 - 3 Lower better

Based on data from 719 participants in 1 study

Follow up 52 weeks

Mean cough score
-

Moderate

Due to serious imprecision²

Use of bronchodilators and ICS likely results in little to no difference in patient completed daily score after 52 weeks when compared to placebo in patients with chronic cough and COPD

(Calverley, 2003)

Difference: MD 0.09 lower

(CI 95% 0.17 lower - 0.01 higher)

Cough frequency

No evidence was found

No evidence was found regarding the effect of bronchodilators and ICS on cough frequency when compared with placebo in patients with chronic cough

*data cited from ERS guideline

Imprecision: serious. Duration of study; not long enough to observe changes in health.
Imprecision: serious. 95% CI was consistent with the possibility of improving and the possibility of worsening symptoms or no effect (continuous outcome)

References

Summary of literature

Description of studies

We included five studies from the ERS guideline (Morice, 2020) in our analysis. The update of the search added two new studies that were included in the analysis of the literature. Important study characteristics and results of the new studies are summarized in table 2. The assessment of the risk of bias is summarized in the risk of bias tables (under the tab ‘Evidence tabellen’). Following the ERS guidelines, we describe included studies using four categories within anti-asthmatic drugs: leukotriene receptor antagonists (LTRA), bronchodilators, inhaled corticosteroids (ICS), bronchodilators and ICS combined. For details of the studies included in the ERS guideline, please refer to the supplementary material of that guideline.

Leukotriene receptor antagonists (LTRA).

The ERS guideline included one randomized study, Spector (2004), on the effect of LTRA (montelukast) in patients with cough-variant asthma after 4 weeks. In total 8 patients in the intervention and 6 patients in the control group were included. The updated search did not result in additional studies on leukotriene receptor antagonists.

Bronchodilators.

The ERS guideline included one randomized study on the effect of bronchodilators in patients with COPD (Calverley, 2003) after 52 weeks. In total 372 patients in the intervention and 361 patients in the control group were included.

The updated search resulted in one additional study. Fukumitsu (2023) performed a randomized, parallel, open-label drug comparator-controlled study to determine antitussive effects of tiotropium for chronic cough refractory compared to ICS and Long-Acting Beta Agonists (LABA). Included patients were adults with asthma whose cough lasted for eight weeks or more. Other coexisting conditions such as allergic rhinitis (AR), chronic rhinosinusitis (CRS) or gastroesophageal reflux disease (GERD) were allowed if patients received adequate treatment. Six patients did not complete the study. An intention-to-treat analysis was performed.

Inhaled corticosteroids (ICS).

The ERS guideline included three randomized studies on the effect of ICS in patients with chronic cough (Boulet, 1994; Riberio, 2007) and symptoms suggestive of asthma (Rytila, 2008). In total 128 patients in the intervention and 104 patients in the control group were included.

The updated search resulted in one additional study. Van der Veer (2023) performed a randomized double blind, placebo-controlled trials to investigate ICS/LABA in bronchiectasis patients (confirmed by computed tomography, with daily > 8 weeks cough) with strict exclusion of patients with asthma or COPD. Minimal sample size was 66 participants. There was loss to follow up, primarily due to adverse events of four participants (23.5%) in ICS/LABA group and one participant (5.8%) in placebo group. The study was prematurely terminated because the minimal sample size could not be achieved.

Bronchodilators and ICS.

The ERS guideline included one randomized study on the effect of bronchodilators and ICS combined in patients with COPD: Calverley (2003). In total 358 patients in the intervention and 361 patients in the control group were included. The updated search did not result in additional studies on bronchodilators and ICS.

Table 2. Characteristics of included studies

Study	Participants (number, age, other important characteristics)	Comparison	Follow-up	Outcome measures	Comments	Risk of bias (per outcome measure) *
Individual studies
Van der Veer, 2023	N at baseline Intervention: n=17 Control: n=17 Age (mean, SD) Intervention: 56y (18) Control: 52y (19) Sex, m/f (%M) Intervention: 7/10 (41%) Control: 5/12 (29%) Sign. Differences in aetiology Sign. Differences in smoking status	Intervention: Beclomethasone-formoterol (Fostair) 200/12 µg Control: Placebo twice daily via identical metered-dose aerosol inhalers.	3 months	Crucial outcome Cough-specific quality of life questionnaire -Leicester Cough Questionnaire (mean score, SD), at 1 month Intervention (n=10): 16.4 (2.4) Control (n=12): 16.8 (3) Important outcomes: Treatment specific adverse events (Number of patients with adverse events,%). Intervention: 11/17 (64.7%) Control: 5/17(29.4%)	The study was terminated prematurely due to insufficient inclusion. Loss to follow up: Due to Covid pandemic and further dropouts after adverse events LCQ at 3 months was determined for 11 participants in intervention group versus 16 in placebo group. Study medications was provided by Chiesi Pharmaceuticals. Some authors of the groups received payment from Chiesi pharmaceuticals before submission of the article. However, these seem to be for activities that are not related to this research (e.g. developing E-learning materials).	Cough specific quality of life, LCQ High risk of bias
Fukumitsu, 2023	N at baseline Intervention: 39 Control: 19 Age (mean, SD) Intervention: 53.5y(15.7) Control: 48.4y (15.1) Sex, m/f (%M) Intervention: 9/30 (30%) Control: 4/15 (27%) Sign. Differences in baseline J-LCQ scores.	Intervention: Tiotropium 5 um daily by inhalation (Spiriva resimat, Boehringer Ingelheim). Control: Oral sustained-release theophylline 400 ug once daily after dinner. Treatments for coexisting conditions were allowed, however no new medications during the study period.	4 weeks	Crucial outcome Cough-specific quality of life questionnaire -Japanese- Leicester Cough Questionnaire (mean score, SD), at baseline Intervention: 13.0 (3.8) Control: 10.5 (3.2) Cough severity -VAS score (mean VAS mm, SD), at baseline Intervention: 49.4 (19.9) Control: 55.1 (23.3) Important outcomes: Treatment specific adverse events (Number of patients with adverse events,%). Intervention: 6/38 (16%) Control: 7/14(50%)^**	Loss to follow up: Six patients had loss to follow up in the (n=1 intervention, n=5 control).	Cough specific quality of life, J-LCQ Some risk of bias Cough severity, VAS Some risk of bias

*For further details, see risk of bias table in the appendix

** Fukumitsu (2023) reported adverse events of 15% in the intervention group versus 47% in the control group. Considering loss to follow up, we calculated different percentages of adverse events in the intervention versus control group (see results in table).

Results

LTRA

The ERS guideline included one study that investigated LTRA in patients with cough-variant asthma (Morice, 2020). No new studies were added. See Summary of Findings (SoF) table for the results and conclusions.

Bronchodilators

The ERS guideline included one study on bronchodilators (Morice, 2020), and one study was added (Fukumitsu, 2023).

Cough Specific Quality of life

Two studies reported Cough Specific Quality of life.

One study of the ERS guideline reported quality of life, measured with the SGRQ. Mean difference between intervention and placebo was -2.70 (95%CI -5.08 to 0.32), preferring the intervention although not clinically significant (Calverley, 2003).
Fukumitsu (2023) used the Japanese- Leicester Cough Questionnaire and showed a mean difference between intervention and placebo of -1.30 (95%CI -0.58 to 3.18) at 4 weeks preferring the intervention group. This finding is borderline clinically significant.

Cough severity

Two studies reported cough severity

One study of the ERS guideline reported cough severity (Morice, 2020). Calverley (2003) reports a mean difference in patient completed daily score of 0.08 (95%CI -0.16 to 0.0), preferring the intervention after 52 weeks.
Fukumitsu (2023) used the VAS scale and showed a mean difference of 9.20 points (95%CI -20.38 to -0.18) in favor of the intervention group although not clinically relevant.

Cough frequency

No studies reported cough frequency.

ICS

The ERS guideline included three studies on ICS (Morice, 2020) and one study was added (van der Veer, 2023).

Cough Specific Quality of life

Van der Veer (2023) used the Leicester Cough Questionnaire (LCQ) at 3 months. After three months Van der Veer (2023) report a mean difference in LCQ score of -0.40 (95%CI -3.03 to 2.23) preferring the intervention group, although not clinically significant.

Cough severity

The ERS guideline included three studies that reported cough severity of which outcome measurements where pooled (Boulet, 1994; Ribeiro, 2007; Rytila, 2008). No new studies were added, see the SoF table.

Cough frequency

No studies reported cough frequency.

Bronchodilators and ICS

The ERS guideline included one study that investigated bronchodilators and ICS in adults with chronic cough (Morice, 2020). No new studies were added. See Summary of Findings table for the results and conclusions.

Search and select

A systematic review of the literature was performed to answer the following question(s):

What is the effectiveness and safety of anti-asthmatic drugs compared to a control to treat adult patients with chronic cough?

Table 1. PICO

Patients	Patients (≥18 years old) with chronic cough for a minimum of 8 weeks
Intervention	Anti-asthmatic drugs (ICS and LABA, anticholinergics, montelukast, prednisone, inhaled or systemic corticosteroids, inhaled bronchodilators or anti-leukotrienes, tiotropium)
Control	Placebo or other treatments
Outcomes	Cough specific quality of life, cough severity, cough frequency
Other selection criteria	Study design: systematic reviews (searched in at least two databases, detailed search strategy, risk of bias assessment and results of individual studies available) and randomized controlled trials Published after June, 2018 Full-text English publication available Follow-up period: minimally 4 weeks after start treatment

Relevant outcome measures

The guideline panel considered cough specific quality of life as a critical outcome measure for decision making; and cough severity, cough frequency and cough severity symptom score as an important outcome measure for decision making.

The guideline panel defined the outcome measures as follows:

1. Cough-specific quality of life, measured by:

a. Measured by Cough Quality of Life Questionnaire (CQLQ); a 28-items questionnaire where higher score indicates worse cough-related quality of life.

b. Leicester Cough Questionnaire (LCQ): a 19-items scale where higher scores indicate a better cough-related quality of life.

c. St. George respiratory questionnaire: a 50-items questionnaire, with scores from 0 to 100 and where higher scores indicate more limitations.

d. Other cough-specific questionnaires as defined in the included studies.

2. Cough severity, measured by:

a. Cough severity diary (CSD): as defined by the included study or score of patients cough severity within the last 24 hours on three domains: cough frequency, cough intensity, and impact of cough on life and sleep. Range 0 to 10 per domain, the sum of CSD scores represents the severity of cough (Wang, 2019).

b. Visual Analogue Scale (VAS): range 0 to 100 point; higher score indicates higher severity.

c. Cough symptom score (CSS): questionnaire with a range 0 to 5 points; higher score indicates more severe cough.

d. Other cough severity measurements as defined in the included studies.

3. Cough frequency, as defined in the included studies.

The guideline panel defined clinical relevance boundaries as follows:

1. Cough specific quality of life:

a. CQLQ: minimal important difference of 13 points (Wang, 2019).

b. LCQ: minimal important difference of 1.3 points (Wang, 2019).

c. St. George respiratory questionnaire: minimal important difference of 4 points (Wang, 2019).

2. Cough severity:

a. Cough severity diary: change of 10% in maximum score.

b. VAS: minimal important difference of at least 10 points.

c. Cough symptom score: change of 10% in maximum score (0.5 points).

3. Cough frequency:

a. Events of coughs per hour: 0.91 RR 1.1.

Standardized mean difference (SMD’s) are also reported. The guideline defined SMD’s of >0.5 clinically relevant.

Search and select (Methods)

We used the search strategy of the ERS guideline of Chronic cough (Morice, 2020). For this search, the databases Medline (via OVID), Embase (via Embase.com) and Cochrane database were searched with relevant search terms till June 2018. We adapted and updated this search until December 2024. The detailed search strategy is listed under the tab ‘Literature search strategy’. The systematic literature search resulted in 306 hits. Studies were selected based on the following criteria: systematic reviews and randomized controlled trials that compared anti-asthmatic drugs with placebo or other treatment among adult patients with chronic cough.

Seven studies were initially selected based on title and abstract screening. After reading the full text, five studies were excluded (see the exclusion table under the tab ‘Evidence tabellen’), and two studies (new) were included.

Calverley P, Pauwels R, Vestbo J, et al. Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: a randomised controlled trial. Lancet (London, England). 2003;361(9356):449-456.
Boulet LP, Milot J, Boutet M, St Georges F, Laviolette M. Airway inflammation in nonasthmatic subjects with chronic cough. American journal of respiratory and critical care medicine. 1994;149(2 Pt 1):482-489.
Chaudhuri R, McMahon AD, Thomson LJ, et al. Effect of inhaled corticosteroids on symptom severity and sputum mediator levels in chronic persistent cough. The Journal of allergy and clinical immunology. 2004;113(6):1063-1070.
Dicpinigaitis PV, Dobkin JB, Reichel J. Antitussive effect of the leukotriene receptor antagonist zafirlukast in subjects with cough-variant asthma. The Journal of asthma : official journal of the Association for the Care of Asthma. 2002;39(4):291-297.
Ellul-Micallef R. Effect of terbutaline sulphate in chronic "allergic" cough. British medical journal (Clinical research ed). 1983;287(6397):940-943.
Fukumitsu K, Kanemitsu Y, Kurokawa R, Takeda N, Tajiri T, Nishiyama H, Ito K, Inoue Y, Yamamoto S, Mori Y, Fukuda S, Uemura T, Ohkubo H, Maeno K, Ito Y, Oguri T, Takemura M, Niimi A. Tiotropium for refractory cough in asthma via cough reflex sensitivity: A randomized, parallel, open-label trial. Ann Allergy Asthma Immunol. 2023 Jul;131(1):59-68.e3. doi: 10.1016/j.anai.2023.03.032. Epub 2023 Apr 7. PMID: 37030486.
Holmes PW, Barter CE, Pierce RJ. Chronic persistent cough: use of ipratropium bromide in undiagnosed cases following upper respiratory tract infection. Respiratory medicine. 1992;86(5):425-29.
Kita T, Fujimura M, Ogawa H, et al. Antitussive effects of the leukotriene receptor antagonist montelukast in patients with cough variant asthma and atopic cough. Allergology international : official journal of the Japanese Society of Allergology. 2010;59(2):185-192.
Kozak-Szkopek EU, W. T. Inhalative Budesonid-Therapie bei chronischer Bronchitis. Atemwegs- und Lunkenkrankheiten. 1997;23(9):542-546.
Morice AH, Millqvist E, Bieksiene K, et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J 2020; 55: 1901136 [https://doi.org/10.1183/ 13993003.01136-2019].
Pizzichini MM, Pizzichini E, Parameswaran K, et al. Nonasthmatic chronic cough: No effect of treatment with an inhaled corticosteroid in patients without sputum eosinophilia. Canadian respiratory journal. 1999;6(4):323-330.
Ribeiro M, Pereira CA, Nery LE, Beppu OS, Silva CO. High-dose inhaled beclomethasone treatment in patients with chronic cough: a randomized placebo-controlled study. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2007;99(1):61-68.
Rytila P, Ghaly L, Varghese S, Chung W, Selroos O, Haahtela T. Treatment with inhaled steroids in patients with symptoms suggestive of asthma but with normal lung function. The European respiratory journal. 2008;32(4):989-996.
Spector SL, Tan RA. Effectiveness of montelukast in the treatment of cough variant asthma. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2004;93(3):232-236.
van der Veer T, de Koning Gans JM, Braunstahl GJ, Pieters ALP, van den Berg JMW, Hoek RAS, Kamphuis LSJ, Bakker M, Dubois AVF, Aerts JGJV, van der Eerden MM. The effect of beclomethasone-formoterol versus placebo on chronic cough in patients with non-CF bronchiectasis: the FORZA randomised controlled trial. Eur Respir J. 2023 Jun 29;61(6):2300186. doi: 10.1183/13993003.00186-2023. PMID: 37263749.
Wang Z, Wang M, Wen S, Yu L, Xu X. Types and applications of cough-related questionnaires. J Thorac Dis 2019;11(10):4379-4388. doi: 10.21037/jtd.2019.09.62.
Wesseling GJ, Quaedvlieg M, Wouters EF. Inhaled budesonide in chronic bronchitis. Effects on respiratory impedance. The European respiratory journal. 1991;4(9):1101-1105.

Risk of Bias table

Study reference

(first author, publication year)

Was the allocation sequence adequately generated?

Definitely yes

Probably yes

Probably no

Definitely no

Was the allocation adequately concealed?

Definitely yes

Probably yes

Probably no

Definitely no

Blinding: Was knowledge of the allocated

interventions adequately prevented?

Were patients blinded?

Were healthcare providers blinded?

Were data collectors blinded?

Were outcome assessors blinded?

Were data analysts blinded?

Definitely yes

Probably yes

Probably no

Definitely no

Was loss to follow-up (missing outcome data) infrequent?

Definitely yes

Probably yes

Probably no

Definitely no

Are reports of the study free of selective outcome reporting?

Definitely yes

Probably yes

Probably no

Definitely no

Was the study apparently free of other problems that could put it at a risk of bias?

Definitely yes

Probably yes

Probably no

Definitely no

Overall risk of bias

If applicable/necessary, per outcome measure

LOW

Some concerns

HIGH

Inhaled corticosteroids (ICS)

Van der Veer, 2023

No information

Definitely yes;

Reason: quadruple blinding of participants, care provider, investigator and outcome assessor.

Definitely yes;

Reason: Loss to follow-up was frequent in intervention and control group. Due to SARS CoV-2 pandemic and drop outs there was loss to follow up (1/17 loss to follow up in placebo groups and 6/17 loss to follow up in intervention group)

Definitely yes;

Reason: All relevant outcomes were reported

Definitely no:

Reason: the study was underpowered. Minimally 66 participants were needed to prove 80% power to detect a mean 2.7 point LCQ difference. Only 34 patients were enrolled. Study was terminated earlier due to insufficient enrolment.

High (Cough specific Quality of Life, LCQ)

Due to underpowered sample size and high loss to follow up

Bronchodilators

Fukumitsu, 2023

No information

Definitely no;

Reason: open label trial, probably researcher/care provider knows/indicated allocation

Definitely no

Reason: Open-label trial

Probably yes;

Reason: Loss to follow-up was frequent in intervention (1/39) and control group (5/19). However, an intention to treat analysis was performed.

Definitely yes

Reason: All relevant outcomes were reported

Probably yes;

Reason:
-intervention was compared with medicine instead of placebo
-inhaler technique and patient adherence were not determined. This might have influenced subjective outcomes.

Some (Cough specific Quality of Life, J-LCQ)
Due to lack of blinding

Some (Cough severity, VAS)

Due to lack of blinding

Table of excluded studies

Reference	Reason for exclusion
Lee SE, Lee JH, Kim HJ, Lee BJ, Cho SH, Price D, Morice AH, Song WJ. Inhaled Corticosteroids and Placebo Treatment Effects in Adult Patients With Cough: A Systematic Review and Meta-analysis. Allergy Asthma Immunol Res. 2019 Nov;11(6):856-870. doi: 10.4168/aair.2019.11.6.856. PMID: 31552720; PMCID: PMC6761077.	Wrong publication date. Included articles were included before June 2018. Furthermore, most included articles in this systematic review were already included in the ERS guideline
Sugawara H, Saito A, Yokoyama S, Tsunematsu K, Takahashi H. Comparison of therapeutic effects of inhaled corticosteroids on three subtypes of cough variant asthma as classified by the impulse oscillometry system. Respir Res. 2019 Feb 26;20(1):41. doi: 10.1186/s12931-019-1005-2. PMID: 30808365; PMCID: PMC6390374.	Wrong intervention. Article is mainly about therapeutic effects due to classification in subgroups by impulse oscillometry system.
Côté A, Russell RJ, Boulet LP, Gibson PG, Lai K, Irwin RS, Brightling CE; CHEST Expert Cough Panel. Managing Chronic Cough Due to Asthma and NAEB in Adults and Adolescents: CHEST Guideline and Expert Panel Report. Chest. 2020 Jul;158(1):68-96. doi: 10.1016/j.chest.2019.12.021. Epub 2020 Jan 20. PMID: 31972181.	Wrong population (>12 years) and wrong study design (systematic review with observational data)
Miwa N, Nagano T, Ohnishi H, Nishiuma T, Takenaka K, Shirotani T, Nakajima T, Dokuni R, Kawa Y, Kobayashi K, Funada Y, Kotani Y, Nishimura Y. An Open-Label, Multi-Institutional, Randomized Study to Evaluate the Additive Effect of a Leukotriene Receptor Antagonist on Cough Score in Patients with Cough-Variant Asthma Being Treated with Inhaled Corticosteroids. Kobe J Med Sci. 2018 Dec 4;64(4):E134-E139. PMID: 30728339; PMCID: PMC6347040.	Wrong population (dry cough for 3 weeks or more)
Zhan W, Tang J, Chen X, Yi F, Han L, Liu B, Luo W, Chen Q, Lai K. Duration of treatment with inhaled corticosteroids in nonasthmatic eosinophilic bronchitis: a randomized open label trial. Ther Adv Respir Dis. 2019 Jan-Dec;13:1753466619891520. doi: 10.1177/1753466619891520. PMID: 31847717; PMCID: PMC6920589.	Wrong population (protracted cough >3 weeks)

Beoordelingsdatum en geldigheid

Publicatiedatum : 08-06-2026

Beoordeeld op geldigheid : 08-06-2026

Initiatief en autorisatie

Initiatief:

Nederlandse Vereniging van Artsen voor Longziekten en Tuberculose

Algemene gegevens

De ontwikkeling van deze richtlijnmodule werd ondersteund door het Kennisinstituut van de Federatie Medisch Specialisten (www.demedischspecialist.nl/kennisinstituut) en werd gefinancierd door de Stichting Kwaliteitsgelden Medisch Specialisten (SKMS).

De financier heeft geen enkele invloed gehad op de inhoud van de richtlijnmodule.

Samenstelling werkgroep

Voor het ontwikkelen van deze richtlijn is in 2023 een multidisciplinaire werkgroep ingesteld, bestaande uit vertegenwoordigers van relevante specialismen die betrokken zijn bij de zorg rondom chronische hoest bij volwassen patiënten. De richtlijn is gelijktijdig ontwikkeld met de richtlijn Hoesten in de palliatieve fase voor volwassenen.

Werkgroep

Dr. J.W.K. (Jan Willem) van den Berg (NVALT), longarts, voorzitter werkgroep
Drs. E.J. (Eva) Japenga (NVALT), longarts
Dr. J. (José) de Kluijver (NVALT), longarts
Dr. M. (Martijn) Goosens (NVALT), longarts
Dr. A.J. (Arent Jan) Michels (NVALT), longarts
Dr. D.A. (Derrek) Heuveling (NVKNO), KNO-arts
Dr. E.M.J.M. (Emke) van den Broek (NVKNO), KNO-arts
Dr. H.W.M. (Marleen) van Casteren (Verenso), specialist ouderengeneeskunde en kaderarts palliatieve zorg
Dr. N.J.J. (Eline) Neels (NHG), huisarts
Dr. F.Y.F.L. (Filip) de Vos (NIV), Internist-oncoloog en kaderarts palliatieve zorg

Klankbordgroep

Dr. E. (Ellen) Ricke, Longfonds, Sr. Beleidsadviseur
Dr. L.R. (Laura) de Baaij (NVMDL), maag-darm-lever arts
Dr. B.D.L. (Lidewij) Broekhuizen (NHG), huisarts
H. (Heleen) van Woudenberg (NVLF), stem- en hoestlogopedist
M. (Marjolein) Frelier (NVLF), stem- en hoestlogopedist

Met ondersteuning van

Dhr. H. (Hans) Ket, Literatuurspecialist, Maatschap Van Dusseldorp, Delavux & Ket
Dr. A.C. (Anniek) van Westing, Adviseur, Kennisinstituut van de Federatie Medisch Specialisten
Dr. J.C. (José) Maas, Senior-adviseur, Kennisinstituut van de Federatie Medisch Specialisten
Drs. P.G. (Phylisha) Bloemen - van Heemskerken, Junior-adviseur, Kennisinstituut van de Federatie Medisch Specialisten
Dr. N.L. (Nikita) van der Zwaluw, Senior-adviseur, Kennisinstituut van de Federatie Medisch Specialisten, tot september 2025
Dr. M.S. (Matthijs) Ruiter, Senior-adviseur, Kennisinstituut van de Federatie Medisch Specialisten, vanaf september 2025

Belangenverklaringen

Een overzicht van de belangen van werkgroepleden en het oordeel over het omgaan met eventuele belangen vindt u in onderstaande tabel. De ondertekende belangenverklaringen zijn op te vragen bij het secretariaat van het Kennisinstituut van de Federatie Medisch Specialisten via secretariaat@kennisinstituut.nl.

Tabel Gemelde (neven)functies en belangen werkgroep

Naam	Hoofdfunctie	Nevenwerkzaamheden	Persoonlijke Financiële Belangen	Persoonlijke Relaties	Extern gefinancierd onderzoek	Intell. belangen en reputatie	Overige belangen	Datum	Actie
*Arent Jan* *Michels*	Longarts vrij gevestigd	Voorzitter MSB Anna ziekenhuis (onkostenvergoeding) voorzitter Medische Staf Anna ziekenhuis (onbetaald)	geen vast dienstverband; 2024 geen betaald adviseurschap 2023 adviesbijeenkomst MSD	Geen	Geen	Hoestpolikliniek	Geen	31-12-2024	Geen restricties
*Derrek Heuveling*	Lid, NVKNO	Lid standpuntnota benigne speekselklierpathologie. NVKNO. Lid Kerngroep Laryngologie NVKNO. Penningmeester MSBMiddenNederland UA. KNO-arts MMC.	Geen	Geen	Geen	Geen	Geen	11-05-2024	Geen restricties
*Eline Neels*	* Huisarts, praktijkhouder * Kaderhuisarts Palliatieve zorg	* Medisch coördinator Hospice Clarahotje (betaald) * Lid CPT (betaald) * Commissie richtlijn: toedienen van vocht in de palliatieve fase (betaald)	-	Nee	-	-	-	5-05-2024	Geen restricties
*Emke van den Broek*	UMC Utrecht	Cluster laryngologie en kerngroep laryngologie	Niet van toepassing	Niet van toepassing	Niet van toepassing	Zie boven gedeeld belang wv kno	Niet van toepassing	26-03-2024	Geen restricties
*Eva Japenga*	Longarts Haaglanden medisch centrum Den Haag	Geen	Geen	Geen	Geen	Geen	Eenmalige bijeenkomst MSD-adviesraad Gefapixant (12-4-23)	26-01-2024	Geen restricties
*Jan Willem van den Berg (voorzitter)*	longarts, Isala ziekenhuis Zwolle	Geen	Geen	Geen	Ja: * MSD - Demografie, kwaliteit van leven, Isala Hoestpoli - Projectleider * MSD - The patient journey of patients diagnosed with unexplained and refractory chronic cough in the Isla – Projectleider. Participatie BUS-P3-01 CALM-1-studie, GSK, P2X3 remmer	Hoestpoli; national lead Neurocough CRC ERS	Dienstverlening (adviesraad, spreker etc.) 2020 MSD 2021 GSK, MSD 2023 MSD	16-01-2024	Geen restricties. Onderwerpen van extern gefinancierd onderzoek komen niet terug in de uitgangsvragen. Advies om te stoppen met dienstverlening aan MSD gedurende het richtlijntraject.
*José de Kluijver*	Longarts Reinier de Graaf Ziekenhuis	Hoofdredactieraad NTvAAKI (onbetaald) – eind 2025 gestaakt	Niet van toepassing	Niet van toepassing	Niet van toepassing	Hoestpoli Reinier de Graaf Ziekenhuis	Niet van toepassing	5-01-2024	Geen restricties
*Marleen van Casteren*	Specialist ouderengeneeskunde bij St. Kalorama, betaald voor 0,8 FTE	Palliatief consulent bij PZNL voor ongeveer 1 uur per week Gastdocent bij Hogeschool Arnhem Nijmegen voor ongeveer 12 uur per jaar Beide worden betaald via mijn werkgever.	Geen	Geen	PALSED studie: * Horizon2020 EU funding - Palliative sedation in patiënts with cancer - Geen projectleider	Geen	Geen	28-02-2024	Geen restricties
*Martijn Goosens*	longarts Gelre Ziekenhuizen, CMSG (Coöperatie Medisch Specialisten Gelre)	Principal investigator meerdere trials, waaronder momenteel 1x studie chronische hoest met een P2X3-receptor antagonist. Incidenteel adviesraden voor farmaceutische industrie, waaronder voor MSD mbt Gefapixant, 2x in 2023.	Geen actuele belangen	Neen	BUS-P3-01 CALM-1-studie: * Bellus Health/GSK - Fase 3 onderzoek P2x3 - Projectleider	geen	geen	3-03-2024	Restricties op besluitvorming over P2X3-receptor antagonist. Advies om adviesraden te staken gedurende de richtlijnontwikkeling.
*Filip de Vos*	Internist-oncoloog en kaderarts palliatieve zorg UMC Utrecht	Geen	Geen	Geen	Ja: * Foundation STOPbraintumors.org - Effect tumorgroei bij vrouwen met laaggradige gliomen - Projectleider * BMS - BET remmer in combinatie met standaard chemoradiatie als eerste lijnsbehandeling bij glioblastoom - Geen projectleider * Novartis - LAG remmer na falen immuuntherapie bij solide tumoren - Geen projectleider * EORTC - Marizomib bij standaard chemoradiatie bij glioblastoom - Projectleider * Pfizer en Ipsen Plharma - Compassionate use medicatie - Geen projectleider	Nee	BMS Advisory Board; Faculty member ESMO CNS tumors; Quality of Care commission Dutch Society of Medical Oncology; Quality Assurance commission EORTC	20-12-2023	Geen restricties. Extern gefinancierd onderzoek buiten bestek van de richtlijn.
*Klankbordgroep*
*Ellen Ricke (tot 2025)*	Sr beleidsadviseur bij Longfonds	Niet van toepassing	Niet van toepassing	Niet van toepassing	Niet van toepassing	Niet van toepassing	Niet van toepassing	29-01-2024	Geen restricties
*Pascale Lubbers*	Beleidsadviseur Longfonds	Geen	Geen	Geen	Geen	Geen	Geen	21-05-2025
*Laura de Baaij*	Maag-darm-leverarts, Reinier de Graaf Gasthuis Verlenen van medisch specialistische zorg op het gebied Maag-darm- en leverziekten, betaald.	Geen	Geen	Geen	Geen	Geen	Geen	24-10-2024	Geen restricties
*Lidewij Broekhuizen*	Huisarts/praktijkhouder in Huisartspraktijk de Bongerd 7271 CG Borculo	Kaderarts astma COPD	Geen	Geen	Nee	Commissielid van de NHG-standaard COPD en Astma voor Volwassenen	Geen	22-08-2024	Geen restricties
*Heleen van Woudenberg*	Logopedie Voorburg - eigen praktijk behandeling van patiënten met vnl. hoest-, stem- en globusklachten. 3 dagen per week, betaald	Geen	Geen	Geen	Geen	Geen	Geen	29-01-2025	Geen restricties
*Marjolein Frelier*	Logopedist Logopedie Voorburg	gastlessen op scholen/opleidingen incidenteel	Geen	Geen	Geen	Geen	Geen	04-02-2025	Geen restricties

Inbreng patiëntenperspectief

De werkgroep besteedde aandacht aan het patiëntenperspectief door afvaardiging van de Longfonds in de klankbordgroep en het uitnodigen van het Longfonds en de Patiëntenfederatie voor de knelpunteninventarisatie. De verkregen input is meegenomen bij het opstellen van de uitgangsvragen, de keuze voor de uitkomstmaten en bij het opstellen van de overwegingen. De conceptrichtlijn is tevens voor commentaar voorgelegd aan het Longfonds en de Patiëntenfederatie en de eventueel aangeleverde commentaren zijn bekeken en verwerkt.

Kwalitatieve raming van mogelijke financiële gevolgen in het kader van de Wkkgz

Bij de richtlijnmodule voerde de werkgroep conform de Wet kwaliteit, klachten en geschillen zorg (Wkkgz) een kwalitatieve raming uit om te beoordelen of de aanbevelingen mogelijk leiden tot substantiële financiële gevolgen. Bij het uitvoeren van deze beoordeling is de richtlijnmodule op verschillende domeinen getoetst (zie het stroomschema bij Werkwijze).

Module	Uitkomst raming	Toelichting
Module Astmamedicatie bij de behandeling van volwassen patiënten met chronische hoest	Geen financiële gevolgen	Hoewel uit de toetsing volgt dat de aanbeveling(en) breed toepasbaar zijn (>40.000 patiënten), volgt ook uit de toetsing dat het geen nieuwe manier van zorgverlening of andere organisatie van zorgverlening betreft. Er worden daarom geen substantiële financiële gevolgen verwacht.

Werkwijze

Voor meer details over de gebruikte richtlijnmethodologie verwijzen wij u naar de Werkwijze. Relevante informatie voor de ontwikkeling/herziening van deze richtlijnmodule is hieronder weergegeven.

Zoekverantwoording

Literature search strategy

Zoekverantwoording

Algemene informatie

Cluster/richtlijn: Chronische hoest bij volwassenen
Uitgangsvraag/modules: UV3 : Wat is de aanbevolen strategie voor het toepassen van astmamedicatie bij de behandeling van volwassen patiënten met chronische hoest?
Database(s): Ovid/Medline, Embase.com	Datum: 15 mei 2024
Periode: vanaf 2018	Talen: geen restrictie
Literatuurspecialist: Hans Ket	Rayyan review: https://rayyan.ai/reviews/1034711
BMI-zoekblokken: voor verschillende opdrachten wordt (deels) gebruik gemaakt van de zoekblokken van BMI-Online https://blocks.bmi-online.nl/ Bij gebruikmaking van een volledig zoekblok zal naar de betreffende link op de website worden verwezen.
Toelichting: Voor deze vraag is gezocht met de concepten: Chronische hoest en uitgebreid astmamedicatie.
Te gebruiken voor richtlijntekst: In de databases Ovid/Medline en Embase.com is systematisch gezocht naar systematische reviews en RCT's over chronische hoest bij volwassenen en astmedicatie. De literatuurzoekactie leverde unieke treffers op.

Zoekopbrengst

	OVID/MEDLINE	EMBASE	Ontdubbeld
SR	25	31	42*
RCT	83	107	153
Totaal	108	138	195

*in Rayyan

Zoekstrategie

Ovid/Medline

Ovid MEDLINE(R) ALL <1946 to May 14, 2024>

1	"Bronchitis, Chronic"/ or (chronic*.ti,ab,kf. and ("Bronchitis"/ or exp "Cough"/ or cough.ti,ab,kf. or coughing.ti,ab,kf. or coughs.ti,ab,kf. or bronchitis.ti,ab,kf. or bronchitic.ti,ab,kf.))	27107
2	"Beclomethasone"/ or exp "Betamethasone"/ or exp "Budesonide"/ or exp "Fluticasone"/ or exp "Mometasone Furoate"/ or exp "Triamcinolone"/ or ciclesonide.nm. or "flunisolide".nm. or exp "Prednisolone"/ or exp "Prednisone"/ or exp "Dexamethasone"/ or exp "Cortisone"/ or exp "Hydrocortisone"/ or exp "Leukotriene Antagonists"/ or montelukast.nm. or pranlukast.nm. or zafirlukast.nm. or exp "Adrenergic beta-2 Receptor Agonists"/ or exp "Formoterol Fumarate"/ or vilanterol.nm. or exp "Salmeterol Xinafoate"/ or indacaterol.nm. or olodaterol.nm. or exp "Albuterol"/ or tulobuterol.nm. or exp "Terbutaline"/ or "Cholinergic Antagonists"/ or exp "Muscarinic Antagonists"/ or exp "Ipratropium"/ or exp "Glycopyrrolate"/ or exp "Tiotropium Bromide"/ or "aclidinium bromide".nm. or gsk573719.nm. or (accolate or accoleit or acetocot or acetospan or acetylcholine-receptor-block* or acetylcholine-receptor-inhibitor* or achr-inhibitor* or aclidinium or acopair or acorspray or actamone or acticort or adbeon or adcortyl or adelcort or adoair or adrecort or adrenalex or adrenergic-beta-2-agonist* or adrenergic-beta-2-receptor-agonist* or adrenocot or advair or aerflu or aerivio or aero-clenil or aerobid or aeroclenil or aerolid or aeroseb or aerospan or aerovent or aerox or aflucoson* or airathon or airbudenid or airbufo or aircort or aircosona or airduo or airexar or airflusal or airing or airtiyo or ala-cort or ala-scalp or albuterol or alenia or aleric or alfacort or alfalyl or algicortis or alisade or alkindi or allercort or allergo-momelind or allermax or allermist or almotex or altyonz or alvesco or alvokast* or anaflogistico or anasma or andipulm or anticholinergic* or antimuscarinic* or antisolon* or anucort or anumed or anutone or aphiahsone or aphtasolon or apilon* or apovent or aprednislon* or aproven or aquacort or aquanil or arcapta or arcodexan* or arinit or aristocort or aristodan or arnuity or artrosone or ascafi or ascolin or asecryl or aservo or asmacaire or asmadil or asmalin or asmanex or asmasal or asmatol or asmaven or asmavent or asmelor or asmenol or asmidon or asmol or asprevent or assieme or assiememite or assolid or astecon or asthator or asthmasan or asthmont or astmirex or astmodil or atem or atenos or atentus or atifor or atimos or atlabiclo or atmadisc or atock or atroaldo or atrodil or atronase or atropinic* or atrovent or aurid or auxiron or avamys or axelovert or azium or azlaire or azmacor or azocutan or barseb or baycadron or becason* or beclometason* or beclomethason* or beglan or belloseta or belokast* or benacort or benarhin or benisolon* or benodil or beprogel or berachin or berisolon* or betacortril or betadexamethason* or betametason* or betamethasolon* or betamethason* or betamethazon* or betamican or betason* or betnasol or betnelan or betnesol or betnovate or betsolan or betsolon or betsopart or biacort or bidexol or bidien or biosonid* or biresp or bloctimo or bodinet or bodix or braltus or breemista or brelomax or bremax or bretaris or brexcort or breyna or brolyt or bronalide or broncho-spray or bronchovent or broncoral or broncoteril or broncovent or bronilide or bronter or bronteral or bropair or brusonex or brytolin* or budamate or budapp or budased or budecol or budecort or budefat or budeflam or budelin or budelite or budena* or budenite or budeno or budenobronch or budenofalk or budenoside or budeprol or buderap or buderen or budes or budesoderm or budesolv or budeson* or budevin or budexan or budiair or budicort or budineb or budixon* or budon or budosan or budo-san or budsocare or bufar or bufoler or bufomix or bufori or bunase or buparid or butacort or butahale or butekont or buto-asma or butolir or butomix or butotal or butovent or buventol or caberdelta or calimix or calonat or campona or capsoid or castispir or cebedex or celestan or celeste or celestene or celeston* or cetacort or cetadexon or chesmon or cholinergic-antagonist* or cholinergic-block* or cholinergic-receptor-antagonist* or cholinolytic-agent* or chronocort or cibutamol or ciclesonide or cidoten or clarinaze or clebudan or cletal or clinacort or clinalog or co-hydeltra or cobadex or codelcortone or colocort or colofoam or compresolon* or coramen or coripen or corlin or corsona or corsone or cort-dome or cortadelton* or cortadren or cortagen or cortalon* or cortandren or cortane or cortastat or cort-dome or cortef or cortelinter or cortenema or cortibel or corticorenol or cortidex or cortidexason* or cortidron* or cortifan or cortiment or cortiphate or cortisal or cortisate or cortisol* or cortison* or cortispray or cortistal or cortisumman or cortivent or cortivite or cortoderm or cortogen or cortone or cortril or cotacort or cotolon* or covocort or cremicort-h or cutaderm or cutticom or cuvposa or cybutol or cycortide or cyntaris or dacortin* or dacrotin or dalalon* or danasone or dartisla or decacortin or decadeltoson* or decaderm or decadion or decadran or decadron* or decaesadril or decagel or decaject or decalix or decamethason* or decaprednil or decason* or decaspray or decasterolon* or decdan or decilon* or decofluor or decortin or decortril or dectancyl or dehydro-cortex or dehydro-hydrocortison* or dehydrocortex or dehydrocortisol* or dehydrohydrocortison* or dekacort or delcortol or delladec or delphicort or delta-hycortol or delta-hydrocortison* or delta-ophticor or delta-stab or deltacortef or delta-cortef or deltacortenolo or deltacortil or deltacortoil or deltacortril or deltaderm or deltafluoren* or deltaglycortril or deltahycort* or deltahydrocortison* or deltaophticor or deltasolon* or deltastab or deltidrosol or deltisolon* or deltolasson* or deltoson* or demoson or depo-predate or deprive or dergramin or deronil or desacort* or desadrene or desalark or desameton* or desdek or desigdron or desona-nasal or de-sone-la or desonix or dexa-cortisyl or dexa-dabrosan or dexa-korti or dexa-scherosan or dexa-scherozon* or dexacen or dexachel or dexacollyre or dexacort* or dexadabroson or dexadecadrol or dexadrol or dexafarma or dexagel or dexagen or dexahelvacort or dexakorti or dexalien or dexaliquid or dexalocal or dexame or dexamecortin* or dexameson* or dexametason* or dexameth* or dexamonozon* or dexan or dexane or dexano or dexa-p or dexapolcort or dexapot or dexascheroson or dexascherozon* or dexason* or dexbudesonide or dexinoral or dexionil or dexmethson* or dexona or dexone or dexpak-taperpak or dextelan or dextenza or dextrasone or dexycu or dezone or dhasolon* or diadreson* or di-adreson* or dibasona or dicortol or dilamax or dilatamol or dioderm or diprolen or domucortone or doxamethason* or duasma or duoresp or duori or ecovent or ecural or eczacort or edelan or edufil or cortelan or efcortelan or efmody or eformoterol or egocort or eklira or eksalb or eldecort or elica or elitasone or ellipta or elocom or elocon or elocyn or elomet or eloson* or eltair or elukan or elunkast* or emmarin or emo-cort or emplusal or encortelon* or encortolon* or encruse or ennhale or entocir or entocord or entocort or enurev or eohilia or eolan or eonic or epicort or equisolon* or esacortene or esonide or euroflu or exadion* or exafil or exicort or eztom or farcolin or favynd or fenorol or fernisolon* or ficortril or filkast* or filocot or firmalon* or fixbufo or flexicort or flonase or flubenisolon* or flumeta or flunisolide or flunitec or fluormethyl-prednisolon* or fluormethylprednisolon* or fluormone or fluorocort or fluorodelta or fluoromethylprednisolon* or fluoxiprednisolon* or fluoxyprednisolon* or fluticasone or fobuler or fobumix or fomeda or fomerol or foracort or foradil* or forair or forarite or forb or forbest or forcap or fordilen or formagal or formano or formatris or formo-easyhaler or formoair or formo-aristo or formoclean or formo-haler or formolich or formonide or formopen or formoresp or formostad or formoterol or formotil or formotop or formovent or forotan or fortasint or fortecortin or forterol or fortulin or foterol or fremomet or frenolyn or frespire or frondava or fulmont or furamist or furamyst or gammacorten* or gardette or gastrodyn or gibiflu or gibiter or giona-easyhaler or glensoludex or glersa or glisend or glistelon* or glycopyrrolat* or glycopyrronium or glycort or gly-cort or glyrx or grafalin or gregal or grosodexon* or gynecort or h-cort or hebcort or hefasolon or hemady or hemril or hexadecadiol or hexadecadrol or hexadiol or hexadrol or hi-cor or hidrotison* or hirobriz or hisone or hitaxa or hokumalin or hokunalin or hostacortin or hycor or hycort or hydeltra or hydeltron* or hydracort or hydrasson or hydrelta or hydro-ricortex or hydrocort* or hydrodeltalon* or hydrodeltisone or hydrogalen or hydrokort* or hydroretrocortin* or hydrotopic or hydventia or hysone or hytisone or hytone or imotec or imvlo or inaladuo or inaspir or incorlin or incortin or incruse or indacaterol or infacort or inflammide or inflanaze or inflanefran or infortispir or inhacort or inhafort or inhalvent or insolon* or instacort or intesticort* or intestifalk or ipra-uni-dose or ipratropium or ipravent or ipraxa or iprohalex or ipvent or isicort or isnacort or isoptodex or isopto-dex or isoptomaxidex or isopto-maxidex or ispyrra or itrop or ivoxel or jepafex or jorveza or kalmente or kenacort or kesol or keteocort or key-pred or kinpeygo or kipres or konex or korticoid or krosalburol or kyypakkaus or lacticare or lanair or larbex or ledercort or lenirit or lenisolon* or leocortol or leucotriene-antagonist* or leukast* or leukotriene-antagonist* or leukotriene-block* or leukotriene-d4-antagonist* or leukotriene-d4-block* or leukotriene-d4-receptor-antagonist* or leukotriene-d4-receptor-block* or leukotriene-inhibit* or leukotriene-receptor-antagonist* or leukotriene-receptor-block* or lexoma or libretin or liferol or liquipred or lisobron or livicort or locasyn or loftan or logren or lokalison or lokilan or lonhala-magnair or lorome or loverine or ludonase or ludonaze or lukair or lukanof or lukas-aiwa or lukasm or lukastang or lukavent or lunibron or lunis or lutio or luxazone or makiren or marvidione or maxidex or mediamethason* or mediasolon* or medihaler or medrocil or mefurosan or megacortin or melarth or mephameson* or meprisolon* or meprisolon* or metacort* or metasolon* or metaspray or methason* or methazon* or meticortelon* or metiderm or meti-derm or metigrenul or metisone-lafi or metmin or metsandia or mexasone or micronyl or miflo or miflonid* or miflonil or mikicort or mildison or millicorten* or milukante or mintalos or mipasu or miralust or mitocortyl or mobinul or modrian or modulair or mofenstra or mofuder or mofunder or mofur or mokast* or molucar or momanose or momate or mome-aiwa or momeallerg or momecort or momegalen or momegen or momekort or momenex or momepax or momesonex or momespir or momester or mometahexal or mometason* or mometaxon* or mometeva or mometop or momil or mommox or monalux or monart or monast or moncas or mondeo or monkasta or monlast or monlucare or monovel or monovo or monspes or monstonol or montair or montast or montecell or montecon or montefar or montegen or montelair or montelak or montelar or montelex or montelubronch or montelucast* or montelukast* or montelux or montemyl or montep or monterast or monteresp or montespir or montewin or montexal or monthan or montol or montus or moolpas or morecort or morlon* or motaderm or movesan or mozal or mundoson or munitren or muofuder or muscarinic-antagonist* or muscarinic-block* or muscarinic-receptor-antagonist* or muscarinic-receptor-block* or muscarinolytic-agent* or muzanlo or mydrapred or mymethason* or butenedioate or isopropylatropinium or nambrol or nanocort or narilet or nasalide or nasamet or nasarel or nasehaler or nasoaldo or nasomet or nasometin or nasonex or nasotason* or nebbud or nebulgen or nebulin or nebu-trop or nefecon or nenoxin or neo-delta or neoforderx or neofordex or neo-rinactive or neovent or netonox or newtock or niciane or nisolon* or nisomethasona or nodapton or nodexon or nogenic or novocort or novohydrocort or novopulmon or novosalmol or numark or nutracort or obecirol or obusonid or oftan-dexa or olfex or olfosonide or olmoran or olodaterol or omcilon or omnaris or onbrez or onbrize or onon or ophtamesone or opredsone or optef or opticorten or opticortinol or oradexan or oradexon or oradexone or orbufox or orest or orgadrone or orilukast* or orimox or orseba or ortikos or oslif or ospertus or otelus or otosone or ovison or ovixan or oxez or oxeze or oxis or oxodil-pph or ozurdex or panafcortelon* or panafcortolon* or panafort or paracortol or parasma or parasympathetic* or parasympatholytic* or parasympaticolytic* or penecort or pentafeno or perasm or perazone or perforomist or pharmecort or phlogex or pidexon or plenadren or pluralais or plusvent or pneumo-kast* or polcortolon or policort or posurdex or pranlukast* or pre-cortisyl or preconin or precortalon or precortancyl or precortisyl or predacort or predaject or predalon* or predartrin* or predate or predeltilon* or predisole or predisyr or pred-ject-50 or predne-dome or prednecort or prednedome or prednelan or predni-coelin or prednicoelin or prednicort* or predni or prednifor or predniment or predniretard or prednis* or prednivet or prednorsolon* or predonine or predorgasolon* or preferid or prelon* or prenilon* or prenin or prenolon* or prepcort or preventan or prevex or prezolon or proctocort or procto-kit or proctosert or proctosol or proctosone or proctozone or procutan or prodexon* or promonta or pronasal or proventil or pulentia or pulmalio or pulmaxan or pulmelia or pulmicon or pulmicort or pulmictan or pulmihal or pulmist or pulmol or pulmoliseflam or pulmoresp or pulmotide or pulmoton or pulmovance or rasec or rectasol or rectocort or rederm or relovair or relukas or relvar or repetabs or resata or respicort or respilukas or respimix or respix or respolin or respontin or revinty-ellipta or rhinalar or rhinatec or rhinex-relief or rhinizill or rhinobros or rhinocort or rhinoside or ribujet or ribuspir or ribuvent or ricortex or rilast or rinalgit or rinaspray or rinatec or rinderon or rinelon or rineton or rinoatem or rinoff or rinometasone or rinoster or rivelon or robinal or robinol or robinul or rodinolon* or rolufta or romilast or saflineb or salamol or salbuair or salbulin or salbumol or salbupart or salbutamol or salbuvent or salden or salgem or salmetedur or salmeter* or salmol or saltos or sanamethason* or sanatison or sanergal or santenson or santeson or saslong or sawasone or schericur or scherisolon* or scheroson* or sebanez or seebri or seffalair or serbo or sereflo or seretide or serevent or serflu or serilon* or serobid or seroflo or sialanar or simacort or sinestic or singodem or singulair or singulergy or sinuva or sirdupla or sistral-hydrocort or solbutamol or solok or solondo or solon* or soltel or solupren* or solurex or sonalox or sortel or spacehaler or spiricort or spiriva or spirocort or spirokast* or spiromon or spolotane or spoloven or srivasso or sroton or sterane or sterasone or sterocort or sterolon* or stie-cort or striverdi or strodin or sultanol or supercortisol or supercortizol or surfair or symbicort or symbiocort or symlukast* or synaclyn or synacort or syntaris or tafen-nasal or talgan or taracortelon* or tarodyl or tarodyn or tarpeyo or telelux or telukast* or teluki or temon or terbutalin* or tevalukast* or texacort or thilodexine or thordel or tinkair or tiogiva or tiotropium or tiotrus or tiova or tolubuterol or tovanor or tramcinolon* or triacortyl or triam-injekt or triam-a or triamcet or triamcimetil or triamcinolon* or triamcort or triamcot or triam-forte or triamonide-40 or triamsicort or triancinolon or triburon or tricinolon or tudorza or tuloboterol or tulobuterol or turobuterol or uceris or ultair or ultibro or ultrabeta or ulunar-breezhaler or umeclidinium or uniclar or unicort or utibron or u-tri-lon* or valnuen or vannair or vanticon or vasocort or velorium or velukast* or venetlin or ventilan or ventodisk* or ventol or veramyst or vericort or vernoral or vertine or vexamet or viani or vilanterol or vinecort or visumetazone or visumethazone or vividrin-mometasone-furoate or volmac or volon or vyaler or vylaer or walacort or walesolon* or weldinide or wixela-inhub or wysolon* or xaira or xoterna or yekast* or zafirlukast* or zafiron or zafirst or zakomoxit or zamitrel or zefecort or zentacort or zeqmelit or zetonna or zhekort or zodgane or zulavent or zuvair or zyolaif or (inhal* adj3 corticosteroid*)).ti,ab,kf.	479142
3	1 and 2	1770
4	3 not ((exp "Adolescent"/ or exp "Child"/ or exp "Infant"/) not exp "Adult"/)	1641
5	limit 4 to yr="2018 -Current"	362
6	meta-analysis/ or meta-analysis as topic/ or (metaanaly* or meta-analy* or metanaly).ti,ab,kf. or systematic review/ or cochrane.jw. or (prisma or prospero).ti,ab,kf. or ((systemati or scoping or umbrella or "structured literature") adj3 (review* or overview)).ti,ab,kf. or (systemic adj1 review).ti,ab,kf. or ((systemati or literature or database* or data-base) adj10 search).ti,ab,kf. or ((structured or comprehensive* or systemic) adj3 search).ti,ab,kf. or ((literature adj3 review) and (search or database* or data-base)).ti,ab,kf. or (("data extraction" or "data source") and "study selection").ti,ab,kf. or ("search strategy" and "selection criteria").ti,ab,kf. or ("data source" and "data synthesis").ti,ab,kf. or (medline or pubmed or embase or cochrane).ab. or ((critical or rapid) adj2 (review or overview* or synthes)).ti. or (((critical or rapid) adj3 (review or overview* or synthes)) and (search or database* or data-base)).ab. or (metasynthes or meta-synthes*).ti,ab,kf.	746134
7	5 and 6	25
8	exp clinical trial/ or randomized controlled trial/ or exp clinical trials as topic/ or randomized controlled trials as topic/ or Random Allocation/ or Double-Blind Method/ or Single-Blind Method/ or (clinical trial, phase i or clinical trial, phase ii or clinical trial, phase iii or clinical trial, phase iv or controlled clinical trial or randomized controlled trial or multicenter study or clinical trial).pt. or random.ti,ab. or (clinic adj trial).tw. or ((singl or doubl* or treb* or tripl) adj (blind$3 or mask$3)).tw. or Placebos/ or placebo.tw.	2725793
9	5 and 8	99
10	9 not 7	83
11	7 or 10	108

Embase.com

No.	Query	Results
#11	#10 NOT #8	107
#10	#6 AND #9	126
#9	'randomized controlled trial'/exp OR random:ti,ab OR (((pragmatic OR practical) NEAR/1 'clinical trial'):ti,ab) OR ((('non inferiority' OR noninferiority OR superiority OR equivalence) NEAR/3 trial*):ti,ab) OR rct:ti,ab,kw	2197979
#8	#6 AND #7	31
#7	'meta analysis'/exp OR 'meta analysis (topic)'/exp OR metaanaly:ti,ab OR 'meta analy':ti,ab OR metanaly:ti,ab OR 'systematic review'/de OR 'cochrane database of systematic reviews'/jt OR prisma:ti,ab OR prospero:ti,ab OR (((systemati OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview)):ti,ab) OR ((systemic NEAR/1 review):ti,ab) OR (((systemati OR literature OR database* OR 'data base') NEAR/10 search):ti,ab) OR (((structured OR comprehensive* OR systemic) NEAR/3 search):ti,ab) OR (((literature NEAR/3 review):ti,ab) AND (search:ti,ab OR database:ti,ab OR 'data base':ti,ab)) OR (('data extraction':ti,ab OR 'data source':ti,ab) AND 'study selection':ti,ab) OR ('search strategy':ti,ab AND 'selection criteria':ti,ab) OR ('data source':ti,ab AND 'data synthesis':ti,ab) OR medline:ab OR pubmed:ab OR embase:ab OR cochrane:ab OR (((critical OR rapid) NEAR/2 (review* OR overview* OR synthes)):ti) OR ((((critical OR rapid) NEAR/3 (review OR overview* OR synthes)):ab) AND (search:ab OR database:ab OR 'data base':ab)) OR metasynthes:ti,ab OR 'meta synthes':ti,ab	1028536
#6	#5 AND [2018-2024]/py	421
#5	#4 NOT ('conference abstract'/it OR 'editorial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp)	1827
#4	#3 NOT (('adolescent'/exp OR 'child'/exp) NOT ('adult'/exp OR 'aged'/exp OR 'middle aged'/exp))	2752
#3	#1 AND #2	2992
#2	('beclometasone'/exp OR 'betamethasone'/exp OR 'budesonide'/exp OR 'budesonide plus formoterol'/exp OR 'fluticasone'/exp OR 'fluticasone propionate plus salmeterol'/exp OR 'mometasone furoate'/exp OR 'triamcinolone'/exp OR 'ciclesonide'/exp OR 'ciclesonide plus formoterol'/exp OR 'flunisolide'/exp OR 'prednisolone'/exp OR 'dexamethasone'/exp OR 'cortisone'/exp OR 'hydrocortisone'/exp OR 'leukotriene receptor blocking agent'/exp OR 'montelukast'/exp OR 'pranlukast'/exp OR 'zafirlukast'/exp OR 'beta 2 adrenergic receptor stimulating agent'/exp OR 'formoterol fumarate'/exp OR 'vilanterol'/exp OR 'fluticasone furoate plus vilanterol'/exp OR 'salmeterol xinafoate'/exp OR 'fluticasone propionate plus salmeterol xinafoate'/exp OR 'indacaterol'/exp OR 'glycopyrronium bromide plus indacaterol'/exp OR 'olodaterol'/exp OR 'salbutamol'/exp OR 'tulobuterol'/exp OR 'terbutaline'/exp OR 'cholinergic receptor blocking agent'/exp OR 'muscarinic receptor blocking agent'/exp OR 'ipratropium bromide'/exp OR 'glycopyrronium'/exp OR 'tiotropium bromide'/exp OR 'aclidinium bromide'/exp OR 'umeclidinium'/exp) AND (accolate:ti,ab,kw OR accoleit:ti,ab,kw OR acetocot:ti,ab,kw OR acetospan:ti,ab,kw OR 'acetylcholine receptor block':ti,ab,kw OR 'acetylcholine receptor inhibitor':ti,ab,kw OR 'achr inhibitor':ti,ab,kw OR aclidinium:ti,ab,kw OR acopair:ti,ab,kw OR acorspray:ti,ab,kw OR actamone:ti,ab,kw OR acticort:ti,ab,kw OR adbeon:ti,ab,kw OR adcortyl:ti,ab,kw OR adelcort:ti,ab,kw OR adoair:ti,ab,kw OR adrecort:ti,ab,kw OR adrenalex:ti,ab,kw OR 'adrenergic beta 2 agonist':ti,ab,kw OR 'adrenergic beta 2 receptor agonist':ti,ab,kw OR adrenocot:ti,ab,kw OR advair:ti,ab,kw OR aerflu:ti,ab,kw OR aerivio:ti,ab,kw OR 'aero clenil':ti,ab,kw OR aerobid:ti,ab,kw OR aeroclenil:ti,ab,kw OR aerolid:ti,ab,kw OR aeroseb:ti,ab,kw OR aerospan:ti,ab,kw OR aerovent:ti,ab,kw OR aerox:ti,ab,kw OR aflucoson:ti,ab,kw OR airathon:ti,ab,kw OR airbudenid:ti,ab,kw OR airbufo:ti,ab,kw OR aircort:ti,ab,kw OR aircosona:ti,ab,kw OR airduo:ti,ab,kw OR airexar:ti,ab,kw OR airflusal:ti,ab,kw OR airing:ti,ab,kw OR airtiyo:ti,ab,kw OR 'ala cort':ti,ab,kw OR 'ala scalp':ti,ab,kw OR albuterol:ti,ab,kw OR alenia:ti,ab,kw OR aleric:ti,ab,kw OR alfacort:ti,ab,kw OR alfalyl:ti,ab,kw OR algicortis:ti,ab,kw OR alisade:ti,ab,kw OR alkindi:ti,ab,kw OR allercort:ti,ab,kw OR 'allergo momelind':ti,ab,kw OR allermax:ti,ab,kw OR allermist:ti,ab,kw OR almotex:ti,ab,kw OR altyonz:ti,ab,kw OR alvesco:ti,ab,kw OR alvokast:ti,ab,kw OR anaflogistico:ti,ab,kw OR anasma:ti,ab,kw OR andipulm:ti,ab,kw OR anticholinergic:ti,ab,kw OR antimuscarinic:ti,ab,kw OR antisolon:ti,ab,kw OR anucort:ti,ab,kw OR anumed:ti,ab,kw OR anutone:ti,ab,kw OR aphiahsone:ti,ab,kw OR aphtasolon:ti,ab,kw OR apilon:ti,ab,kw OR apovent:ti,ab,kw OR aprednislon:ti,ab,kw OR aproven:ti,ab,kw OR aquacort:ti,ab,kw OR aquanil:ti,ab,kw OR arcapta:ti,ab,kw OR arcodexan:ti,ab,kw OR arinit:ti,ab,kw OR aristocort:ti,ab,kw OR aristodan:ti,ab,kw OR arnuity:ti,ab,kw OR artrosone:ti,ab,kw OR ascafi:ti,ab,kw OR ascolin:ti,ab,kw OR asecryl:ti,ab,kw OR aservo:ti,ab,kw OR asmacaire:ti,ab,kw OR asmadil:ti,ab,kw OR asmalin:ti,ab,kw OR asmanex:ti,ab,kw OR asmasal:ti,ab,kw OR asmatol:ti,ab,kw OR asmaven:ti,ab,kw OR asmavent:ti,ab,kw OR asmelor:ti,ab,kw OR asmenol:ti,ab,kw OR asmidon:ti,ab,kw OR asmol:ti,ab,kw OR asprevent:ti,ab,kw OR assieme:ti,ab,kw OR assiememite:ti,ab,kw OR assolid:ti,ab,kw OR astecon:ti,ab,kw OR asthator:ti,ab,kw OR asthmasan:ti,ab,kw OR asthmont:ti,ab,kw OR astmirex:ti,ab,kw OR astmodil:ti,ab,kw OR atem:ti,ab,kw OR atenos:ti,ab,kw OR atentus:ti,ab,kw OR atifor:ti,ab,kw OR atimos:ti,ab,kw OR atlabiclo:ti,ab,kw OR atmadisc:ti,ab,kw OR atock:ti,ab,kw OR atroaldo:ti,ab,kw OR atrodil:ti,ab,kw OR atronase:ti,ab,kw OR atropinic:ti,ab,kw OR atrovent:ti,ab,kw OR aurid:ti,ab,kw OR auxiron:ti,ab,kw OR avamys:ti,ab,kw OR axelovert:ti,ab,kw OR azium:ti,ab,kw OR azlaire:ti,ab,kw OR azmacor:ti,ab,kw OR azocutan:ti,ab,kw OR barseb:ti,ab,kw OR baycadron:ti,ab,kw OR becason:ti,ab,kw OR beclometason:ti,ab,kw OR beclomethason:ti,ab,kw OR beglan:ti,ab,kw OR belloseta:ti,ab,kw OR belokast:ti,ab,kw OR benacort:ti,ab,kw OR benarhin:ti,ab,kw OR benisolon:ti,ab,kw OR benodil:ti,ab,kw OR beprogel:ti,ab,kw OR berachin:ti,ab,kw OR berisolon:ti,ab,kw OR betacortril:ti,ab,kw OR betadexamethason:ti,ab,kw OR betametason:ti,ab,kw OR betamethasolon:ti,ab,kw OR betamethason:ti,ab,kw OR betamethazon:ti,ab,kw OR betamican:ti,ab,kw OR betason:ti,ab,kw OR betnasol:ti,ab,kw OR betnelan:ti,ab,kw OR betnesol:ti,ab,kw OR betnovate:ti,ab,kw OR betsolan:ti,ab,kw OR betsolon:ti,ab,kw OR betsopart:ti,ab,kw OR biacort:ti,ab,kw OR bidexol:ti,ab,kw OR bidien:ti,ab,kw OR biosonid:ti,ab,kw OR biresp:ti,ab,kw OR bloctimo:ti,ab,kw OR bodinet:ti,ab,kw OR bodix:ti,ab,kw OR braltus:ti,ab,kw OR breemista:ti,ab,kw OR brelomax:ti,ab,kw OR bremax:ti,ab,kw OR bretaris:ti,ab,kw OR brexcort:ti,ab,kw OR breyna:ti,ab,kw OR brolyt:ti,ab,kw OR bronalide:ti,ab,kw OR 'broncho spray':ti,ab,kw OR bronchovent:ti,ab,kw OR broncoral:ti,ab,kw OR broncoteril:ti,ab,kw OR broncovent:ti,ab,kw OR bronilide:ti,ab,kw OR bronter:ti,ab,kw OR bronteral:ti,ab,kw OR bropair:ti,ab,kw OR brusonex:ti,ab,kw OR brytolin:ti,ab,kw OR budamate:ti,ab,kw OR budapp:ti,ab,kw OR budased:ti,ab,kw OR budecol:ti,ab,kw OR budecort:ti,ab,kw OR budefat:ti,ab,kw OR budeflam:ti,ab,kw OR budelin:ti,ab,kw OR budelite:ti,ab,kw OR budena:ti,ab,kw OR budenite:ti,ab,kw OR budeno:ti,ab,kw OR budenobronch:ti,ab,kw OR budenofalk:ti,ab,kw OR budenoside:ti,ab,kw OR budeprol:ti,ab,kw OR buderap:ti,ab,kw OR buderen:ti,ab,kw OR budes:ti,ab,kw OR budesoderm:ti,ab,kw OR budesolv:ti,ab,kw OR budeson:ti,ab,kw OR budevin:ti,ab,kw OR budexan:ti,ab,kw OR budiair:ti,ab,kw OR budicort:ti,ab,kw OR budineb:ti,ab,kw OR budixon:ti,ab,kw OR budon:ti,ab,kw OR budosan:ti,ab,kw OR 'budo san':ti,ab,kw OR budsocare:ti,ab,kw OR bufar:ti,ab,kw OR bufoler:ti,ab,kw OR bufomix:ti,ab,kw OR bufori:ti,ab,kw OR bunase:ti,ab,kw OR buparid:ti,ab,kw OR butacort:ti,ab,kw OR butahale:ti,ab,kw OR butekont:ti,ab,kw OR 'buto asma':ti,ab,kw OR butolir:ti,ab,kw OR butomix:ti,ab,kw OR butotal:ti,ab,kw OR butovent:ti,ab,kw OR buventol:ti,ab,kw OR caberdelta:ti,ab,kw OR calimix:ti,ab,kw OR calonat:ti,ab,kw OR campona:ti,ab,kw OR capsoid:ti,ab,kw OR castispir:ti,ab,kw OR cebedex:ti,ab,kw OR celestan:ti,ab,kw OR celeste:ti,ab,kw OR celestene:ti,ab,kw OR celeston:ti,ab,kw OR cetacort:ti,ab,kw OR cetadexon:ti,ab,kw OR chesmon:ti,ab,kw OR 'cholinergic antagonist':ti,ab,kw OR 'cholinergic block':ti,ab,kw OR 'cholinergic receptor antagonist':ti,ab,kw OR 'cholinolytic agent':ti,ab,kw OR chronocort:ti,ab,kw OR cibutamol:ti,ab,kw OR ciclesonide:ti,ab,kw OR cidoten:ti,ab,kw OR clarinaze:ti,ab,kw OR clebudan:ti,ab,kw OR cletal:ti,ab,kw OR clinacort:ti,ab,kw OR clinalog:ti,ab,kw OR 'co hydeltra':ti,ab,kw OR cobadex:ti,ab,kw OR codelcortone:ti,ab,kw OR colocort:ti,ab,kw OR colofoam:ti,ab,kw OR compresolon:ti,ab,kw OR coramen:ti,ab,kw OR coripen:ti,ab,kw OR corlin:ti,ab,kw OR corsona:ti,ab,kw OR corsone:ti,ab,kw OR cortadelton:ti,ab,kw OR cortadren:ti,ab,kw OR cortagen:ti,ab,kw OR cortalon:ti,ab,kw OR cortandren:ti,ab,kw OR cortane:ti,ab,kw OR cortastat:ti,ab,kw OR 'cort dome':ti,ab,kw OR cortef:ti,ab,kw OR cortelinter:ti,ab,kw OR cortenema:ti,ab,kw OR cortibel:ti,ab,kw OR corticorenol:ti,ab,kw OR cortidex:ti,ab,kw OR cortidexason:ti,ab,kw OR cortidron:ti,ab,kw OR cortifan:ti,ab,kw OR cortiment:ti,ab,kw OR cortiphate:ti,ab,kw OR cortisal:ti,ab,kw OR cortisate:ti,ab,kw OR cortisol:ti,ab,kw OR cortison:ti,ab,kw OR cortispray:ti,ab,kw OR cortistal:ti,ab,kw OR cortisumman:ti,ab,kw OR cortivent:ti,ab,kw OR cortivite:ti,ab,kw OR cortoderm:ti,ab,kw OR cortogen:ti,ab,kw OR cortone:ti,ab,kw OR cortril:ti,ab,kw OR cotacort:ti,ab,kw OR cotolon:ti,ab,kw OR covocort:ti,ab,kw OR 'cremicort h':ti,ab,kw OR cutaderm:ti,ab,kw OR cutticom:ti,ab,kw OR cuvposa:ti,ab,kw OR cybutol:ti,ab,kw OR cycortide:ti,ab,kw OR cyntaris:ti,ab,kw OR dacortin:ti,ab,kw OR dacrotin:ti,ab,kw OR dalalon:ti,ab,kw OR danasone:ti,ab,kw OR dartisla:ti,ab,kw OR decacortin:ti,ab,kw OR decadeltoson:ti,ab,kw OR decaderm:ti,ab,kw OR decadion:ti,ab,kw OR decadran:ti,ab,kw OR decadron:ti,ab,kw OR decaesadril:ti,ab,kw OR decagel:ti,ab,kw OR decaject:ti,ab,kw OR decalix:ti,ab,kw OR decamethason:ti,ab,kw OR decaprednil:ti,ab,kw OR decason:ti,ab,kw OR decaspray:ti,ab,kw OR decasterolon:ti,ab,kw OR decdan:ti,ab,kw OR decilon:ti,ab,kw OR decofluor:ti,ab,kw OR decortin:ti,ab,kw OR decortril:ti,ab,kw OR dectancyl:ti,ab,kw OR 'dehydro cortex':ti,ab,kw OR 'dehydro hydrocortison':ti,ab,kw OR dehydrocortex:ti,ab,kw OR dehydrocortisol:ti,ab,kw OR dehydrohydrocortison:ti,ab,kw OR dekacort:ti,ab,kw OR delcortol:ti,ab,kw OR delladec:ti,ab,kw OR delphicort:ti,ab,kw OR 'delta hycortol':ti,ab,kw OR 'delta hydrocortison':ti,ab,kw OR 'delta ophticor':ti,ab,kw OR 'delta stab':ti,ab,kw OR deltacortef:ti,ab,kw OR 'delta cortef':ti,ab,kw OR deltacortenolo:ti,ab,kw OR deltacortil:ti,ab,kw OR deltacortoil:ti,ab,kw OR deltacortril:ti,ab,kw OR deltaderm:ti,ab,kw OR deltafluoren:ti,ab,kw OR deltaglycortril:ti,ab,kw OR deltahycort:ti,ab,kw OR deltahydrocortison:ti,ab,kw OR deltaophticor:ti,ab,kw OR deltasolon:ti,ab,kw OR deltastab:ti,ab,kw OR deltidrosol:ti,ab,kw OR deltisolon:ti,ab,kw OR deltolasson:ti,ab,kw OR deltoson:ti,ab,kw OR demoson:ti,ab,kw OR 'depo predate':ti,ab,kw OR deprive:ti,ab,kw OR dergramin:ti,ab,kw OR deronil:ti,ab,kw OR desacort:ti,ab,kw OR desadrene:ti,ab,kw OR desalark:ti,ab,kw OR desameton:ti,ab,kw OR desdek:ti,ab,kw OR desigdron:ti,ab,kw OR 'desona nasal':ti,ab,kw OR 'de sone la':ti,ab,kw OR desonix:ti,ab,kw OR 'dexa cortisyl':ti,ab,kw OR 'dexa dabrosan':ti,ab,kw OR 'dexa korti':ti,ab,kw OR 'dexa scherosan':ti,ab,kw OR 'dexa scherozon':ti,ab,kw OR dexacen:ti,ab,kw OR dexachel:ti,ab,kw OR dexacollyre:ti,ab,kw OR dexacort:ti,ab,kw OR dexadabroson:ti,ab,kw OR dexadecadrol:ti,ab,kw OR dexadrol:ti,ab,kw OR dexafarma:ti,ab,kw OR dexagel:ti,ab,kw OR dexagen:ti,ab,kw OR dexahelvacort:ti,ab,kw OR dexakorti:ti,ab,kw OR dexalien:ti,ab,kw OR dexaliquid:ti,ab,kw OR dexalocal:ti,ab,kw OR dexame:ti,ab,kw OR dexamecortin:ti,ab,kw OR dexameson:ti,ab,kw OR dexametason:ti,ab,kw OR dexameth:ti,ab,kw OR dexamonozon:ti,ab,kw OR dexan:ti,ab,kw OR dexane:ti,ab,kw OR dexano:ti,ab,kw OR 'dexa p':ti,ab,kw OR dexapolcort:ti,ab,kw OR dexapot:ti,ab,kw OR dexascheroson:ti,ab,kw OR dexascherozon:ti,ab,kw OR dexason:ti,ab,kw OR dexbudesonide:ti,ab,kw OR dexinoral:ti,ab,kw OR dexionil:ti,ab,kw OR dexmethson:ti,ab,kw OR dexona:ti,ab,kw OR dexone:ti,ab,kw OR 'dexpak taperpak':ti,ab,kw OR dextelan:ti,ab,kw OR dextenza:ti,ab,kw OR dextrasone:ti,ab,kw OR dexycu:ti,ab,kw OR dezone:ti,ab,kw OR dhasolon:ti,ab,kw OR diadreson:ti,ab,kw OR 'di adreson':ti,ab,kw OR dibasona:ti,ab,kw OR dicortol:ti,ab,kw OR dilamax:ti,ab,kw OR dilatamol:ti,ab,kw OR dioderm:ti,ab,kw OR diprolen:ti,ab,kw OR domucortone:ti,ab,kw OR doxamethason:ti,ab,kw OR duasma:ti,ab,kw OR duoresp:ti,ab,kw OR duori:ti,ab,kw OR ecovent:ti,ab,kw OR ecural:ti,ab,kw OR eczacort:ti,ab,kw OR edelan:ti,ab,kw OR edufil:ti,ab,kw OR cortelan:ti,ab,kw OR efcortelan:ti,ab,kw OR efmody:ti,ab,kw OR eformoterol:ti,ab,kw OR egocort:ti,ab,kw OR eklira:ti,ab,kw OR eksalb:ti,ab,kw OR eldecort:ti,ab,kw OR elica:ti,ab,kw OR elitasone:ti,ab,kw OR ellipta:ti,ab,kw OR elocom:ti,ab,kw OR elocon:ti,ab,kw OR elocyn:ti,ab,kw OR elomet:ti,ab,kw OR eloson:ti,ab,kw OR eltair:ti,ab,kw OR elukan:ti,ab,kw OR elunkast:ti,ab,kw OR emmarin:ti,ab,kw OR 'emo cort':ti,ab,kw OR emplusal:ti,ab,kw OR encortelon:ti,ab,kw OR encortolon:ti,ab,kw OR encruse:ti,ab,kw OR ennhale:ti,ab,kw OR entocir:ti,ab,kw OR entocord:ti,ab,kw OR entocort:ti,ab,kw OR enurev:ti,ab,kw OR eohilia:ti,ab,kw OR eolan:ti,ab,kw OR eonic:ti,ab,kw OR epicort:ti,ab,kw OR equisolon:ti,ab,kw OR esacortene:ti,ab,kw OR esonide:ti,ab,kw OR euroflu:ti,ab,kw OR exadion:ti,ab,kw OR exafil:ti,ab,kw OR exicort:ti,ab,kw OR eztom:ti,ab,kw OR farcolin:ti,ab,kw OR favynd:ti,ab,kw OR fenorol:ti,ab,kw OR fernisolon:ti,ab,kw OR ficortril:ti,ab,kw OR filkast:ti,ab,kw OR filocot:ti,ab,kw OR firmalon:ti,ab,kw OR fixbufo:ti,ab,kw OR flexicort:ti,ab,kw OR flonase:ti,ab,kw OR flubenisolon:ti,ab,kw OR flumeta:ti,ab,kw OR flunisolide:ti,ab,kw OR flunitec:ti,ab,kw OR 'fluormethyl prednisolon':ti,ab,kw OR fluormethylprednisolon:ti,ab,kw OR fluormone:ti,ab,kw OR fluorocort:ti,ab,kw OR fluorodelta:ti,ab,kw OR fluoromethylprednisolon:ti,ab,kw OR fluoxiprednisolon:ti,ab,kw OR fluoxyprednisolon:ti,ab,kw OR fluticasone:ti,ab,kw OR fobuler:ti,ab,kw OR fobumix:ti,ab,kw OR fomeda:ti,ab,kw OR fomerol:ti,ab,kw OR foracort:ti,ab,kw OR foradil:ti,ab,kw OR forair:ti,ab,kw OR forarite:ti,ab,kw OR forb:ti,ab,kw OR forbest:ti,ab,kw OR forcap:ti,ab,kw OR fordilen:ti,ab,kw OR formagal:ti,ab,kw OR formano:ti,ab,kw OR formatris:ti,ab,kw OR 'formo easyhaler':ti,ab,kw OR formoair:ti,ab,kw OR 'formo aristo':ti,ab,kw OR formoclean:ti,ab,kw OR 'formo haler':ti,ab,kw OR formolich:ti,ab,kw OR formonide:ti,ab,kw OR formopen:ti,ab,kw OR formoresp:ti,ab,kw OR formostad:ti,ab,kw OR formoterol:ti,ab,kw OR formotil:ti,ab,kw OR formotop:ti,ab,kw OR formovent:ti,ab,kw OR forotan:ti,ab,kw OR fortasint:ti,ab,kw OR fortecortin:ti,ab,kw OR forterol:ti,ab,kw OR fortulin:ti,ab,kw OR foterol:ti,ab,kw OR fremomet:ti,ab,kw OR frenolyn:ti,ab,kw OR frespire:ti,ab,kw OR frondava:ti,ab,kw OR fulmont:ti,ab,kw OR furamist:ti,ab,kw OR furamyst:ti,ab,kw OR gammacorten:ti,ab,kw OR gardette:ti,ab,kw OR gastrodyn:ti,ab,kw OR gibiflu:ti,ab,kw OR gibiter:ti,ab,kw OR 'giona easyhaler':ti,ab,kw OR glensoludex:ti,ab,kw OR glersa:ti,ab,kw OR glisend:ti,ab,kw OR glistelon:ti,ab,kw OR glycopyrrolat:ti,ab,kw OR glycopyrronium:ti,ab,kw OR glycort:ti,ab,kw OR 'gly cort':ti,ab,kw OR glyrx:ti,ab,kw OR grafalin:ti,ab,kw OR gregal:ti,ab,kw OR grosodexon:ti,ab,kw OR gynecort:ti,ab,kw OR 'h cort':ti,ab,kw OR hebcort:ti,ab,kw OR hefasolon:ti,ab,kw OR hemady:ti,ab,kw OR hemril:ti,ab,kw OR hexadecadiol:ti,ab,kw OR hexadecadrol:ti,ab,kw OR hexadiol:ti,ab,kw OR hexadrol:ti,ab,kw OR 'hi cor':ti,ab,kw OR hidrotison:ti,ab,kw OR hirobriz:ti,ab,kw OR hisone:ti,ab,kw OR hitaxa:ti,ab,kw OR hokumalin:ti,ab,kw OR hokunalin:ti,ab,kw OR hostacortin:ti,ab,kw OR hycor:ti,ab,kw OR hycort:ti,ab,kw OR hydeltra:ti,ab,kw OR hydeltron:ti,ab,kw OR hydracort:ti,ab,kw OR hydrasson:ti,ab,kw OR hydrelta:ti,ab,kw OR 'hydro ricortex':ti,ab,kw OR hydrocort:ti,ab,kw OR hydrodeltalon:ti,ab,kw OR hydrodeltisone:ti,ab,kw OR hydrogalen:ti,ab,kw OR hydrokort:ti,ab,kw OR hydroretrocortin:ti,ab,kw OR hydrotopic:ti,ab,kw OR hydventia:ti,ab,kw OR hysone:ti,ab,kw OR hytisone:ti,ab,kw OR hytone:ti,ab,kw OR imotec:ti,ab,kw OR imvlo:ti,ab,kw OR inaladuo:ti,ab,kw OR inaspir:ti,ab,kw OR incorlin:ti,ab,kw OR incortin:ti,ab,kw OR incruse:ti,ab,kw OR indacaterol:ti,ab,kw OR infacort:ti,ab,kw OR inflammide:ti,ab,kw OR inflanaze:ti,ab,kw OR inflanefran:ti,ab,kw OR infortispir:ti,ab,kw OR inhacort:ti,ab,kw OR inhafort:ti,ab,kw OR inhalvent:ti,ab,kw OR insolon:ti,ab,kw OR instacort:ti,ab,kw OR intesticort:ti,ab,kw OR intestifalk:ti,ab,kw OR 'ipra uni dose':ti,ab,kw OR ipratropium:ti,ab,kw OR ipravent:ti,ab,kw OR ipraxa:ti,ab,kw OR iprohalex:ti,ab,kw OR ipvent:ti,ab,kw OR isicort:ti,ab,kw OR isnacort:ti,ab,kw OR isoptodex:ti,ab,kw OR 'isopto dex':ti,ab,kw OR isoptomaxidex:ti,ab,kw OR 'isopto maxidex':ti,ab,kw OR ispyrra:ti,ab,kw OR itrop:ti,ab,kw OR ivoxel:ti,ab,kw OR jepafex:ti,ab,kw OR jorveza:ti,ab,kw OR kalmente:ti,ab,kw OR kenacort:ti,ab,kw OR kesol:ti,ab,kw OR keteocort:ti,ab,kw OR 'key pred':ti,ab,kw OR kinpeygo:ti,ab,kw OR kipres:ti,ab,kw OR konex:ti,ab,kw OR korticoid:ti,ab,kw OR krosalburol:ti,ab,kw OR kyypakkaus:ti,ab,kw OR lacticare:ti,ab,kw OR lanair:ti,ab,kw OR larbex:ti,ab,kw OR ledercort:ti,ab,kw OR lenirit:ti,ab,kw OR lenisolon:ti,ab,kw OR leocortol:ti,ab,kw OR 'leucotriene antagonist':ti,ab,kw OR leukast:ti,ab,kw OR 'leukotriene antagonist':ti,ab,kw OR 'leukotriene block':ti,ab,kw OR 'leukotriene d4 antagonist':ti,ab,kw OR 'leukotriene d4 block':ti,ab,kw OR 'leukotriene d4 receptor antagonist':ti,ab,kw OR 'leukotriene d4 receptor block':ti,ab,kw OR 'leukotriene inhibit':ti,ab,kw OR 'leukotriene receptor antagonist':ti,ab,kw OR 'leukotriene receptor block':ti,ab,kw OR lexoma:ti,ab,kw OR libretin:ti,ab,kw OR liferol:ti,ab,kw OR liquipred:ti,ab,kw OR lisobron:ti,ab,kw OR livicort:ti,ab,kw OR locasyn:ti,ab,kw OR loftan:ti,ab,kw OR logren:ti,ab,kw OR lokalison:ti,ab,kw OR lokilan:ti,ab,kw OR 'lonhala magnair':ti,ab,kw OR lorome:ti,ab,kw OR loverine:ti,ab,kw OR ludonase:ti,ab,kw OR ludonaze:ti,ab,kw OR lukair:ti,ab,kw OR lukanof:ti,ab,kw OR 'lukas aiwa':ti,ab,kw OR lukasm:ti,ab,kw OR lukastang:ti,ab,kw OR lukavent:ti,ab,kw OR lunibron:ti,ab,kw OR lunis:ti,ab,kw OR lutio:ti,ab,kw OR luxazone:ti,ab,kw OR makiren:ti,ab,kw OR marvidione:ti,ab,kw OR maxidex:ti,ab,kw OR mediamethason:ti,ab,kw OR mediasolon:ti,ab,kw OR medihaler:ti,ab,kw OR medrocil:ti,ab,kw OR mefurosan:ti,ab,kw OR megacortin:ti,ab,kw OR melarth:ti,ab,kw OR mephameson:ti,ab,kw OR meprisolon:ti,ab,kw OR metacort:ti,ab,kw OR metasolon:ti,ab,kw OR metaspray:ti,ab,kw OR methason:ti,ab,kw OR methazon:ti,ab,kw OR meticortelon:ti,ab,kw OR metiderm:ti,ab,kw OR 'meti derm':ti,ab,kw OR metigrenul:ti,ab,kw OR 'metisone lafi':ti,ab,kw OR metmin:ti,ab,kw OR metsandia:ti,ab,kw OR mexasone:ti,ab,kw OR micronyl:ti,ab,kw OR miflo:ti,ab,kw OR miflonid:ti,ab,kw OR miflonil:ti,ab,kw OR mikicort:ti,ab,kw OR mildison:ti,ab,kw OR millicorten:ti,ab,kw OR milukante:ti,ab,kw OR mintalos:ti,ab,kw OR mipasu:ti,ab,kw OR miralust:ti,ab,kw OR mitocortyl:ti,ab,kw OR mobinul:ti,ab,kw OR modrian:ti,ab,kw OR modulair:ti,ab,kw OR mofenstra:ti,ab,kw OR mofuder:ti,ab,kw OR mofunder:ti,ab,kw OR mofur:ti,ab,kw OR mokast:ti,ab,kw OR molucar:ti,ab,kw OR momanose:ti,ab,kw OR momate:ti,ab,kw OR 'mome aiwa':ti,ab,kw OR momeallerg:ti,ab,kw OR momecort:ti,ab,kw OR momegalen:ti,ab,kw OR momegen:ti,ab,kw OR momekort:ti,ab,kw OR momenex:ti,ab,kw OR momepax:ti,ab,kw OR momesonex:ti,ab,kw OR momespir:ti,ab,kw OR momester:ti,ab,kw OR mometahexal:ti,ab,kw OR mometason:ti,ab,kw OR mometaxon:ti,ab,kw OR mometeva:ti,ab,kw OR mometop:ti,ab,kw OR momil:ti,ab,kw OR mommox:ti,ab,kw OR monalux:ti,ab,kw OR monart:ti,ab,kw OR monast:ti,ab,kw OR moncas:ti,ab,kw OR mondeo:ti,ab,kw OR monkasta:ti,ab,kw OR monlast:ti,ab,kw OR monlucare:ti,ab,kw OR monovel:ti,ab,kw OR monovo:ti,ab,kw OR monspes:ti,ab,kw OR monstonol:ti,ab,kw OR montair:ti,ab,kw OR montast:ti,ab,kw OR montecell:ti,ab,kw OR montecon:ti,ab,kw OR montefar:ti,ab,kw OR montegen:ti,ab,kw OR montelair:ti,ab,kw OR montelak:ti,ab,kw OR montelar:ti,ab,kw OR montelex:ti,ab,kw OR montelubronch:ti,ab,kw OR montelucast:ti,ab,kw OR montelukast:ti,ab,kw OR montelux:ti,ab,kw OR montemyl:ti,ab,kw OR montep:ti,ab,kw OR monterast:ti,ab,kw OR monteresp:ti,ab,kw OR montespir:ti,ab,kw OR montewin:ti,ab,kw OR montexal:ti,ab,kw OR monthan:ti,ab,kw OR montol:ti,ab,kw OR montus:ti,ab,kw OR moolpas:ti,ab,kw OR morecort:ti,ab,kw OR morlon:ti,ab,kw OR motaderm:ti,ab,kw OR movesan:ti,ab,kw OR mozal:ti,ab,kw OR mundoson:ti,ab,kw OR munitren:ti,ab,kw OR muofuder:ti,ab,kw OR 'muscarinic antagonist':ti,ab,kw OR 'muscarinic block':ti,ab,kw OR 'muscarinic receptor antagonist':ti,ab,kw OR 'muscarinic receptor block':ti,ab,kw OR 'muscarinolytic agent':ti,ab,kw OR muzanlo:ti,ab,kw OR mydrapred:ti,ab,kw OR mymethason:ti,ab,kw OR butenedioate:ti,ab,kw OR isopropylatropinium:ti,ab,kw OR nambrol:ti,ab,kw OR nanocort:ti,ab,kw OR narilet:ti,ab,kw OR nasalide:ti,ab,kw OR nasamet:ti,ab,kw OR nasarel:ti,ab,kw OR nasehaler:ti,ab,kw OR nasoaldo:ti,ab,kw OR nasomet:ti,ab,kw OR nasometin:ti,ab,kw OR nasonex:ti,ab,kw OR nasotason:ti,ab,kw OR nebbud:ti,ab,kw OR nebulgen:ti,ab,kw OR nebulin:ti,ab,kw OR 'nebu trop':ti,ab,kw OR nefecon:ti,ab,kw OR nenoxin:ti,ab,kw OR 'neo delta':ti,ab,kw OR neoforderx:ti,ab,kw OR neofordex:ti,ab,kw OR 'neo rinactive':ti,ab,kw OR neovent:ti,ab,kw OR netonox:ti,ab,kw OR newtock:ti,ab,kw OR niciane:ti,ab,kw OR nisolon:ti,ab,kw OR nisomethasona:ti,ab,kw OR nodapton:ti,ab,kw OR nodexon:ti,ab,kw OR nogenic:ti,ab,kw OR novocort:ti,ab,kw OR novohydrocort:ti,ab,kw OR novopulmon:ti,ab,kw OR novosalmol:ti,ab,kw OR numark:ti,ab,kw OR nutracort:ti,ab,kw OR obecirol:ti,ab,kw OR obusonid:ti,ab,kw OR 'oftan dexa':ti,ab,kw OR olfex:ti,ab,kw OR olfosonide:ti,ab,kw OR olmoran:ti,ab,kw OR olodaterol:ti,ab,kw OR omcilon:ti,ab,kw OR omnaris:ti,ab,kw OR onbrez:ti,ab,kw OR onbrize:ti,ab,kw OR onon:ti,ab,kw OR ophtamesone:ti,ab,kw OR opredsone:ti,ab,kw OR optef:ti,ab,kw OR opticorten:ti,ab,kw OR opticortinol:ti,ab,kw OR oradexan:ti,ab,kw OR oradexon:ti,ab,kw OR oradexone:ti,ab,kw OR orbufox:ti,ab,kw OR orest:ti,ab,kw OR orgadrone:ti,ab,kw OR orilukast:ti,ab,kw OR orimox:ti,ab,kw OR orseba:ti,ab,kw OR ortikos:ti,ab,kw OR oslif:ti,ab,kw OR ospertus:ti,ab,kw OR otelus:ti,ab,kw OR otosone:ti,ab,kw OR ovison:ti,ab,kw OR ovixan:ti,ab,kw OR oxez:ti,ab,kw OR oxeze:ti,ab,kw OR oxis:ti,ab,kw OR 'oxodil pph':ti,ab,kw OR ozurdex:ti,ab,kw OR panafcortelon:ti,ab,kw OR panafcortolon:ti,ab,kw OR panafort:ti,ab,kw OR paracortol:ti,ab,kw OR parasma:ti,ab,kw OR parasympathetic:ti,ab,kw OR parasympatholytic:ti,ab,kw OR parasympaticolytic:ti,ab,kw OR penecort:ti,ab,kw OR pentafeno:ti,ab,kw OR perasm:ti,ab,kw OR perazone:ti,ab,kw OR perforomist:ti,ab,kw OR pharmecort:ti,ab,kw OR phlogex:ti,ab,kw OR pidexon:ti,ab,kw OR plenadren:ti,ab,kw OR pluralais:ti,ab,kw OR plusvent:ti,ab,kw OR 'pneumo kast':ti,ab,kw OR polcortolon:ti,ab,kw OR policort:ti,ab,kw OR posurdex:ti,ab,kw OR pranlukast:ti,ab,kw OR 'pre cortisyl':ti,ab,kw OR preconin:ti,ab,kw OR precortalon:ti,ab,kw OR precortancyl:ti,ab,kw OR precortisyl:ti,ab,kw OR predacort:ti,ab,kw OR predaject:ti,ab,kw OR predalon:ti,ab,kw OR predartrin:ti,ab,kw OR predate:ti,ab,kw OR predeltilon:ti,ab,kw OR predisole:ti,ab,kw OR predisyr:ti,ab,kw OR 'pred ject 50':ti,ab,kw OR 'predne dome':ti,ab,kw OR prednecort:ti,ab,kw OR prednedome:ti,ab,kw OR prednelan:ti,ab,kw OR 'predni coelin':ti,ab,kw OR prednicoelin:ti,ab,kw OR prednicort:ti,ab,kw OR predni:ti,ab,kw OR prednifor:ti,ab,kw OR predniment:ti,ab,kw OR predniretard:ti,ab,kw OR prednis:ti,ab,kw OR prednivet:ti,ab,kw OR prednorsolon:ti,ab,kw OR predonine:ti,ab,kw OR predorgasolon:ti,ab,kw OR preferid:ti,ab,kw OR prelon:ti,ab,kw OR prenilon:ti,ab,kw OR prenin:ti,ab,kw OR prenolon:ti,ab,kw OR prepcort:ti,ab,kw OR preventan:ti,ab,kw OR prevex:ti,ab,kw OR prezolon:ti,ab,kw OR proctocort:ti,ab,kw OR 'procto kit':ti,ab,kw OR proctosert:ti,ab,kw OR proctosol:ti,ab,kw OR proctosone:ti,ab,kw OR proctozone:ti,ab,kw OR procutan:ti,ab,kw OR prodexon:ti,ab,kw OR promonta:ti,ab,kw OR pronasal:ti,ab,kw OR proventil:ti,ab,kw OR pulentia:ti,ab,kw OR pulmalio:ti,ab,kw OR pulmaxan:ti,ab,kw OR pulmelia:ti,ab,kw OR pulmicon:ti,ab,kw OR pulmicort:ti,ab,kw OR pulmictan:ti,ab,kw OR pulmihal:ti,ab,kw OR pulmist:ti,ab,kw OR pulmol:ti,ab,kw OR pulmoliseflam:ti,ab,kw OR pulmoresp:ti,ab,kw OR pulmotide:ti,ab,kw OR pulmoton:ti,ab,kw OR pulmovance:ti,ab,kw OR rasec:ti,ab,kw OR rectasol:ti,ab,kw OR rectocort:ti,ab,kw OR rederm:ti,ab,kw OR relovair:ti,ab,kw OR relukas:ti,ab,kw OR relvar:ti,ab,kw OR repetabs:ti,ab,kw OR resata:ti,ab,kw OR respicort:ti,ab,kw OR respilukas:ti,ab,kw OR respimix:ti,ab,kw OR respix:ti,ab,kw OR respolin:ti,ab,kw OR respontin:ti,ab,kw OR 'revinty ellipta':ti,ab,kw OR rhinalar:ti,ab,kw OR rhinatec:ti,ab,kw OR 'rhinex relief':ti,ab,kw OR rhinizill:ti,ab,kw OR rhinobros:ti,ab,kw OR rhinocort:ti,ab,kw OR rhinoside:ti,ab,kw OR ribujet:ti,ab,kw OR ribuspir:ti,ab,kw OR ribuvent:ti,ab,kw OR ricortex:ti,ab,kw OR rilast:ti,ab,kw OR rinalgit:ti,ab,kw OR rinaspray:ti,ab,kw OR rinatec:ti,ab,kw OR rinderon:ti,ab,kw OR rinelon:ti,ab,kw OR rineton:ti,ab,kw OR rinoatem:ti,ab,kw OR rinoff:ti,ab,kw OR rinometasone:ti,ab,kw OR rinoster:ti,ab,kw OR rivelon:ti,ab,kw OR robinal:ti,ab,kw OR robinol:ti,ab,kw OR robinul:ti,ab,kw OR rodinolon:ti,ab,kw OR rolufta:ti,ab,kw OR romilast:ti,ab,kw OR saflineb:ti,ab,kw OR salamol:ti,ab,kw OR salbuair:ti,ab,kw OR salbulin:ti,ab,kw OR salbumol:ti,ab,kw OR salbupart:ti,ab,kw OR salbutamol:ti,ab,kw OR salbuvent:ti,ab,kw OR salden:ti,ab,kw OR salgem:ti,ab,kw OR salmetedur:ti,ab,kw OR salmeter:ti,ab,kw OR salmol:ti,ab,kw OR saltos:ti,ab,kw OR sanamethason:ti,ab,kw OR sanatison:ti,ab,kw OR sanergal:ti,ab,kw OR santenson:ti,ab,kw OR santeson:ti,ab,kw OR saslong:ti,ab,kw OR sawasone:ti,ab,kw OR schericur:ti,ab,kw OR scherisolon:ti,ab,kw OR scheroson:ti,ab,kw OR sebanez:ti,ab,kw OR seebri:ti,ab,kw OR seffalair:ti,ab,kw OR serbo:ti,ab,kw OR sereflo:ti,ab,kw OR seretide:ti,ab,kw OR serevent:ti,ab,kw OR serflu:ti,ab,kw OR serilon:ti,ab,kw OR serobid:ti,ab,kw OR seroflo:ti,ab,kw OR sialanar:ti,ab,kw OR simacort:ti,ab,kw OR sinestic:ti,ab,kw OR singodem:ti,ab,kw OR singulair:ti,ab,kw OR singulergy:ti,ab,kw OR sinuva:ti,ab,kw OR sirdupla:ti,ab,kw OR 'sistral hydrocort':ti,ab,kw OR solbutamol:ti,ab,kw OR solok:ti,ab,kw OR solondo:ti,ab,kw OR solon:ti,ab,kw OR soltel:ti,ab,kw OR solupren:ti,ab,kw OR solurex:ti,ab,kw OR sonalox:ti,ab,kw OR sortel:ti,ab,kw OR spacehaler:ti,ab,kw OR spiricort:ti,ab,kw OR spiriva:ti,ab,kw OR spirocort:ti,ab,kw OR spirokast:ti,ab,kw OR spiromon:ti,ab,kw OR spolotane:ti,ab,kw OR spoloven:ti,ab,kw OR srivasso:ti,ab,kw OR sroton:ti,ab,kw OR sterane:ti,ab,kw OR sterasone:ti,ab,kw OR sterocort:ti,ab,kw OR sterolon:ti,ab,kw OR 'stie cort':ti,ab,kw OR striverdi:ti,ab,kw OR strodin:ti,ab,kw OR sultanol:ti,ab,kw OR supercortisol:ti,ab,kw OR supercortizol:ti,ab,kw OR surfair:ti,ab,kw OR symbicort:ti,ab,kw OR symbiocort:ti,ab,kw OR symlukast:ti,ab,kw OR synaclyn:ti,ab,kw OR synacort:ti,ab,kw OR syntaris:ti,ab,kw OR 'tafen nasal':ti,ab,kw OR talgan:ti,ab,kw OR taracortelon:ti,ab,kw OR tarodyl:ti,ab,kw OR tarodyn:ti,ab,kw OR tarpeyo:ti,ab,kw OR telelux:ti,ab,kw OR telukast:ti,ab,kw OR teluki:ti,ab,kw OR temon:ti,ab,kw OR terbutalin:ti,ab,kw OR tevalukast:ti,ab,kw OR texacort:ti,ab,kw OR thilodexine:ti,ab,kw OR thordel:ti,ab,kw OR tinkair:ti,ab,kw OR tiogiva:ti,ab,kw OR tiotropium:ti,ab,kw OR tiotrus:ti,ab,kw OR tiova:ti,ab,kw OR tolubuterol:ti,ab,kw OR tovanor:ti,ab,kw OR tramcinolon:ti,ab,kw OR triacortyl:ti,ab,kw OR 'triam injekt':ti,ab,kw OR 'triam a':ti,ab,kw OR triamcet:ti,ab,kw OR triamcimetil:ti,ab,kw OR triamcinolon:ti,ab,kw OR triamcort:ti,ab,kw OR triamcot:ti,ab,kw OR 'triam forte':ti,ab,kw OR 'triamonide 40':ti,ab,kw OR triamsicort:ti,ab,kw OR triancinolon:ti,ab,kw OR triburon:ti,ab,kw OR tricinolon:ti,ab,kw OR tudorza:ti,ab,kw OR tuloboterol:ti,ab,kw OR tulobuterol:ti,ab,kw OR turobuterol:ti,ab,kw OR uceris:ti,ab,kw OR ultair:ti,ab,kw OR ultibro:ti,ab,kw OR ultrabeta:ti,ab,kw OR 'ulunar breezhaler':ti,ab,kw OR umeclidinium:ti,ab,kw OR uniclar:ti,ab,kw OR unicort:ti,ab,kw OR utibron:ti,ab,kw OR 'u tri lon':ti,ab,kw OR valnuen:ti,ab,kw OR vannair:ti,ab,kw OR vanticon:ti,ab,kw OR vasocort:ti,ab,kw OR velorium:ti,ab,kw OR velukast:ti,ab,kw OR venetlin:ti,ab,kw OR ventilan:ti,ab,kw OR ventodisk:ti,ab,kw OR ventol:ti,ab,kw OR veramyst:ti,ab,kw OR vericort:ti,ab,kw OR vernoral:ti,ab,kw OR vertine:ti,ab,kw OR vexamet:ti,ab,kw OR viani:ti,ab,kw OR vilanterol:ti,ab,kw OR vinecort:ti,ab,kw OR visumetazone:ti,ab,kw OR visumethazone:ti,ab,kw OR 'vividrin mometasone furoate':ti,ab,kw OR volmac:ti,ab,kw OR volon:ti,ab,kw OR vyaler:ti,ab,kw OR vylaer:ti,ab,kw OR walacort:ti,ab,kw OR walesolon:ti,ab,kw OR weldinide:ti,ab,kw OR 'wixela inhub':ti,ab,kw OR wysolon:ti,ab,kw OR xaira:ti,ab,kw OR xoterna:ti,ab,kw OR yekast:ti,ab,kw OR zafirlukast:ti,ab,kw OR zafiron:ti,ab,kw OR zafirst:ti,ab,kw OR zakomoxit:ti,ab,kw OR zamitrel:ti,ab,kw OR zefecort:ti,ab,kw OR zentacort:ti,ab,kw OR zeqmelit:ti,ab,kw OR zetonna:ti,ab,kw OR zhekort:ti,ab,kw OR zodgane:ti,ab,kw OR zulavent:ti,ab,kw OR zuvair:ti,ab,kw OR zyolaif:ti,ab,kw OR ((inhal NEAR/3 corticosteroid*):ti,ab,kw))	323821
#1	'chronic cough'/exp OR 'chronic bronchitis'/exp OR (chronic*:ti,ab,kw AND ('bronchitis'/de OR 'coughing'/exp OR cough:ti,ab,kw OR coughing:ti,ab,kw OR coughs:ti,ab,kw OR bronchitis:ti,ab,kw OR bronchitic:ti,ab,kw))	59570

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