Feature Article

Managing cough in adults: is there a serious underlying cause?

Benjamin Kwan, Chin Goh



A thorough history and physical examination, as well as targeted investigations, adequate treatment trials and the option of combining therapeutic approaches are important components of an effective management plan in patients with acute and chronic cough. Serious underlying causes such as malignancy, pneumonia or congestive cardiac failure should be excluded.

Key Points

  • A detailed medical history and physical examination are important in managing patients with cough.
  • Acute cough is defined as cough lasting less than three weeks and chronic as lasting more than eight weeks.
  • Acute cough is commonly caused by infections (especially viral) of the respiratory tract.
  • It is important to exclude serious illness as a cause of acute cough and to exclude a postinfectious cause in patients with subacute cough.
  • A trial of cessation of medications that can cause cough is recommended.
  • Chronic cough is strongly associated with smoking. Upper airway cough syndrome, asthma or gastro-oesophageal reflux disease are the most likely causes of chronic cough in a healthy nonsmoker.
  • A combined therapeutic approach in sequential steps and referral of the patient to a specialist may be required in the management of chronic cough.