WAO-ARIA consensus on chronic cough - Part III: Management strategies in primary and cough-specialty care. Updates inCOVID-19

Chronic cough management necessitates a clear integrated care pathway approach. Primary care physicians initially encounter the majority of chronic cough patients, yet their role in proper management can prove challenging due to limited access to advanced diagnostic testing. A multidisciplinary approach involving otolaryngologists and chest physicians, allergists, and gastroenterologists, among others, is central to the optimal diagnosis and treatment of conditions which underly or worsen cough. These include infectious and inflammatory, upper and lower airway pathologies, or gastro-esophageal reflux. Despite the wide armamentarium of ancillary testing conducted in cough multidisciplinary care, such management can improve cough but seldom resolves it completely. This can be due partly to the limited data on the role of tests (eg, spirometry, exhaled nitric oxide), as well as classical pharmacotherapy conducted in multidisciplinary specialties for chronic cough. Other important factors include presence of multiple concomitant cough trigger mechanisms and the central neuronal complexity of chronic cough. Subsequent management conducted by cough specialists aims at control of cough refractory to prior interventions and includes cough-specific behavioral counseling and pharmacotherapy with neuromodulators, among others. Preliminary data on the role of neuromodulators in a proof-of-concept manner are encouraging but lack strong evidence on efficacy and safety.The World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough reviewed the recent literature on management of chronic cough in primary, multidisciplinary, and cough-specialty care. Knowledge gaps in diagnostic testing, classical and neuromodulator pharmacotherapy, in addition to behavioral therapy of chronic cough were also analyzed.This third part of the WAO/ARIA consensus on chronic cough suggests a management algorithm of chronic cough in an integrated care pathway approach. Insights into the inherent limitations of multidisciplinary cough diagnostic testing, efficacy and safety of currently available antitussive pharmacotherapy, or the recently recognized behavioral therapy, can significantly improve the standards of care in patients with chronic cough

The emblematic minnows of the North American Great Plains: A synthesis of threats and conservation opportunities

© 2017 John Wiley & Sons Ltd. Anthropogenic changes to the Great Plains rivers of North America have had a large, negative effect on a reproductive guild of pelagic-broadcast spawning (PBS) cyprinid fishes. The group is phylogenetically diverse, with multiple origins of the PBS mode. However, because of incomplete life-history information, PBS designation often relies only on habitat and egg characteristics. We identified 17 known or candidate PBS fishes and systematically synthesized the literature on their biology and ecology in relation to major threats to persistence. Research output on an individual species was unrelated to conservation status, but positively correlated with breadth of distribution. The PBS species have opportunistic life-history strategies and are typically short-lived (generally 1-3 years) fishes. Many PBS species have truncated ranges showing declines in both distribution and abundance, especially those endemic to the Rio Grande catchment. Fundamental habitat associations are unknown for many species, particularly regarding seasonal shifts and early life stages. Critical thermal tolerances have been quantified for five PBS species and are generally > 35°C. Turbidity and salinity changes are linked to responses at multiple life stages, but information is lacking on interactions between water quality and quantity. Hydrologic alteration appears to be a primary threat to PBS species, through complex interactions with landscape fragmentation, and habitat change. We highlight areas where scientific and management communities are lacking information and underline areas of potential conservation gain