A critical review of the quality of cough clinical practice guidelines.

Clinical practice guidelines (CPGs) have been developed to provide healthcare practitioners with the best possible evidence, but their quality varies greatly.To systematically evaluate the quality of cough CPGs and identify gaps limiting evidence-based practice.Systematic searches were conducted to identify cough CPGs in guideline databases, developers' websites and MEDLINE. Four reviewers independently evaluated eligible guidelines using Appraisal of Guidelines for Research and Evaluation II (AGREE II). Agreement among reviewers was assessed by intra-class correlation coefficient. The number of recommendations, strength of recommendation, and levels of evidence were determined.Fifteen cough CPGs were identified. An overall high-degree agreement among reviewers was observed (intra-class correlation coefficient: 0.82; 95% confidence interval: 0.79-0.85). The quality ranged from good to acceptable in scope and purpose (mean: 72%, range: 54-93%) and clarity and presentation domains (mean: 68%, range: 50-90%), but not in stakeholder involvement (mean: 36%, range: 18-90%), rigour of development (mean: 36%, range: 9-93%), applicability (mean: 23%, range: 9-83%) and editorial independence domains (mean: 24%, range: 0-96%). Seven guidelines (46.7%) were considered 'strongly recommended' or 'recommended with modifications' for clinical practice. More than 70% of recommendations were based on non-randomized studies (level C, 30.4%) and expert opinion (level D, 41.3%).The quality of cough CPGs is variable and recommendations are largely based on low-quality evidence. There is a significant room for improvement to develop high-quality guidelines, which urgently warrants high-quality researches to minimize the vital gaps in the evidence for formulation of cough CPGs.