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Review
Chronic cough: a practical approach to assessment and management
  1. Abhinav Mathur1,
  2. Patrick S K Liu-Shiu-Cheong1,
  3. Ami Munro2,
  4. Graeme P Currie2
  1. 1Chest Clinic C, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
  2. 2Banchory Group Practice, Dee St, Banchory, UK
  1. Correspondence to Abhinav Mathur; abhinav.mathur{at}nhs.net

https://doi.org/10.1136/dtb.2018.000014

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    Key learning points

    • Chronic cough is a common reason for presentation to primary care; it has multiple respiratory and non-respiratory causes.

    • In many patients, minimal baseline investigations lead to an easily identifiable and treatable cause. In others, no specific cause can be identified even after extensive investigations.

    • In non-smoking patients who are not taking an ACE inhibitor and who have a normal chest X-ray, the most common causes of chronic cough are asthma, gastro-oesophageal reflux disease and upper airway cough syndrome.

    • There is an emerging theory that chronic idiopathic cough may represent a neuropathic disorder.

    • A growing evidence base indicates that speech and language therapy may be helpful in the management of recalcitrant chronic cough.

    Introduction

    Cough is one of the most common symptoms that leads to a consultation in primary care.1 However, studies highlight that awareness of clinical guidelines on the management of cough among general practitioners (GPs) has been low and referral to specialist clinics may be premature.1,2 In this article, we review the management of adults with chronic cough in primary care and focus upon initial assessment and management strategies.

    What is cough?

    Cough is a reflex action with a degree of voluntary and involuntary control. It is mediated by afferent sensory nerves (initiated by a wide variety of stimuli) resulting in forced expulsion against a closed glottis. Cough is arbitrarily defined as chronic when it lasts >8 weeks and can result from many conditions.3 Patients who have no clear cause after guideline-based assessment and investigation (see box 1), and who fail to respond to empirical treatments are usually labelled as having chronic idiopathic cough.4,5 It is important to differentiate chronic idiopathic cough from refractory chronic cough in which an explanation usually exists (eg, chronic obstructive pulmonary disease [COPD]) but the cough remains despite treatment of the underlying condition.

    Box 1:

    Chronic cough clinical guidelines

    • British …

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    Footnotes

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.