A systematic review of methods of citric acid cough reflex testing

Emma Wallace, Esther Guiu Hernandez, Alicia Ang, Sarah Hiew, Phoebe Macrae

Research output: Contribution to journalReview articlepeer-review

10 Citations (Scopus)



This systematic review summarises and appraises methods of citric acid cough reflex testing (CRT) documented in published literature.


Electronic databases, MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus were searched up to and including 11th February 2018. Studies reporting a method of citric acid CRT, published in peer-reviewed journals in English or Spanish, were assessed for the inclusion criteria. Of the selected studies, information on the instrumentation and CRT protocol was extracted.


A total of 129 studies were included. Instrumentation and protocols differed widely across studies. Reporting of methods of citric acid CRT was sub-standard, with many crucial methodological components omitted from published manuscripts, preventing their full replication.


Considerable methodological variability exists for citric acid CRT in published literature. The findings suggest that caution is warranted in comparing citric acid cough thresholds across studies. Full replication of previously published methods of citric acid CRT is limited due to crucial elements of the citric acid CRT protocol being omitted from published manuscripts. These findings have implications on the use of citric acid CRT in clinical and pharmaceutical studies to evaluate the effects of antitussive medications and cough therapies.

Original languageEnglish
Article number101827
Number of pages15
JournalPulmonary Pharmacology and Therapeutics
Publication statusPublished - 1 Oct 2019
Externally publishedYes


  • Citric acid
  • Cough
  • Cough reflex test


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