S2k-Leitlinie Fachärztliche Diagnostik und Therapie von erwachsenen Patienten mit Husten

Zusammenfassung

Die vorliegende 4. Ausgabe der deutschen fachärztlichen S2k-Leitlinie wurde im Auftrag der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin unter Teilnahme von – durch die jeweiligen Gesellschaften akkreditierten – Allergologen, HNO-Ärzten, Gastroenterologen, Internisten, Logopäden und Physiotherapeuten sowie eines Patientenvertreters unter Leitung eines Systematikers erstellt. Sie soll die S3-Husten-Leitlinie der Deutschen Gesellschaft für Allgemeinmedizin (DEGAM) im Hinblick auf spezielle Fragestellungen ergänzen.

Sie hat gegenüber den früheren Versionen 1–3, die einen Monografie-Charakter hatten, ein völlig neues Konzept. In einem modifizierten Delphi-Verfahren erarbeiteten die Autoren 12 Schlüsselfragen, die in der Leitlinienkonferenz beantwortet und auf der Basis der vorliegenden Evidenz abgestimmt und nach Soll- (stark), Sollte- (schwache) oder Kann-Empfehlung (keine ausreichende Evidenz/Erfahrung) graduiert worden waren. Anschließend wurde ein kurzer wissenschaftlicher Hintergrund zu den jeweiligen Fragen durch sachverständige Gruppen der Autoren erarbeitet. Teilweise neue Diagnostik-Algorithmen wurden für den akuten, subakuten und chronischen Husten erstellt.

Durch den deutlich reduzierten Umfang und bessere Übersicht ist die Leitlinie für die tägliche Praxis besser anwendbar. Sie wurde außerdem in die Smartphone App Leila Pro aufgenommen und ist mit den dortigen Komfortfunktionen abrufbar.

Die Leitlinie enthält folgende Schlüsselfragen:

 1. Wie wird Husten klassifiziert?

 2. Was sind die häufigsten Ursachen für den akuten und subakuten Husten?

 3. Welche Alarmzeichen („red flags“) erfordern eine unverzügliche ausführliche Diagnostik und ggf. Therapie?

 4. Was sind häufige Ursachen für den chronischen Husten?

 5. Ist die SARS-CoV-2-Infektion bei der Abklärung des Hustens relevant?

 6. Was ist chronisch refraktärer oder chronisch idiopathischer Husten?

 7. Können chronische Erkrankungen der oberen Atemwege chronischen Husten auslösen?

 8. Kann gastroösophagealer Reflux chronischen Husten verursachen?

 9. Kann eine bronchiale Hyperreagibilität (BHR) oder eine eosinophile Entzündung der Bronchien (NAEB) ohne klassisches Asthma für den chronischen Husten verantwortlich sein?

10. Gibt es Medikamente, die chronischen Husten verursachen können?

11. Welche Basisdiagnostik und personalisierte Diagnostik sind erforderlich, um den chronischen Husten abzuklären?

12. Welche nicht-medikamentösen und medikamentösen Therapien gibt es für den Husten?

Abstract

This is the 4^th edition of the Cough Guidelines of the German Respiratory Society written by respiratory, gastroenterology, ear-nose-throat specialists, including respiratory physiotherapists and speech pathology specialists; importantly, a patient representative was also involved.

Compared with earlier versions we used a new methodology: after discussion in the guidelines group, we asked and answered the 12 most important and most frequent “key” questions regarding the clinical practice. The extent of the guideline could thus be significantly reduced.

We added a short scientific background to each of the answers including the most recent references. The recommendations and statements were created in consensus and graded as strong, or weak. If sufficient literature was not available, we suggested discussing joint decisions with the patient.

The 12 key questions are as follows:

– Key question 1: The classification of cough (acute, i. e. up to three weeks duration; chronic, i. e. after 8 weeks duration and subacute in between) did not change, but we added “cough with or without expectoration as an additional classification aspect with therapeutic consequences.

– Key question 2: Acute and subacute cough are mostly (but not exclusively) due to the common cold. They are the first or second most frequent symptom prompting patients to seek medical (or pharmacist’s) care. Antibiotic therapy is strongly discouraged for common cold

– Key question 3: We defined “Red flags” for mandatory immediate diagnostic for acute cough, which usually does not require such diagnostic procedures

– Key question 4: Chronic cough overview of the most common causes for

– Key question 5: Cough in acute SARS-CoV-2 infection and in long COVID

– Key question 6: Refractory chronic cough and idiopathic chronic cough, two recently established entities were explained more in detail

– Key question 7: To upper airway cough syndrome

– Key question 8: Gastro-oesophageal-reflux-related cough

– Key question 9: Cough-variant asthma and non-asthmatic eosinophilic bronchitis

– Key question 10: Overview of drugs causing cough

– Key question 11: Basic and personalized (due to the individual history) diagnostic procedures for patients with cough

– Key question 12: Physiotherapy, speech therapy and pharmacotherapy for cough

Publikationsverlauf

Artikel online veröffentlicht:
12. Mai 2025

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