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Feature Article

Chronic cough: a guide to evaluation and management

Antony BX Breslin, Alvin Jinpung Ing

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Abstract

A chronic persistent cough can be exhausting for the patient and a real challenge for the doctor. With a systematic approach to dealing with the problem, the chances of effecting a satisfactory therapeutic outcome are very good.

Key Points

  • The most effective management is specific therapy directed at the underlying cause, which results in a positive response in more than 80% of patients. Therefore, a careful assessment to identify the cause of chronic cough is important.
  • A chest x-ray should be taken early in the clinical investigation of chronic cough.
  • The three most common causes of chronic cough when chest x-rays are normal are postnasal discharge, bronchial asthma and occult gastro-oesophageal reflux.
  • Remember that cough may be the sole manifestation of occult reflux or asthma.
  • Causes of chronic cough can coexist. If one cause seems likely, this should be treated; if multiple causes seem likely and important, treatment should be directed at each.
  • Referral to a thoracic physician should be considered if the patient’s x-ray is abnormal, if the x-ray is normal but there is no response to first line therapy over three to four weeks, or if serious symptoms exist (e.g. haemoptysis).

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