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Feature Article

Management of chronic cough in adults

Rob G Stirling

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Abstract

Cough is one of the most common causes of presentation to GPs. Although not life threatening, chronic cough causes severe impairment of a patient’s quality of life. Algorithm-based approaches to investigation and empirical treatment for the four common causes should resolve this condition in more than 90% of cases.

Key Points

  • Cough is one of the most common causes of presentation to GPs. Chronic cough causes major physical and psychological morbidity.
  • Chronic cough may be assessed qualitatively and semiquantitatively using cough counters and cough sensitivity testing.
  • In most cases, chronic cough is caused by asthma, gastro-oesophageal reflux disease (GORD), postnasal drip syndrome or chronic bronchitis.
  • Appropriate investigation and empirical treatment should control cough in the majority of individuals. If cause-specific treatment fails then a trial of antitussive therapy is indicated to suppress the cough.
  • If algorithm-directed investigation and treatment of chronic cough is unsuccessful then referral to a cough clinic may be appropriate.

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