Chronic Cough: Evaluation and Management

Charlie Michaudet, MD; John Malaty, MD

Disclosures

Am Fam Physician. 2017;96(9):575-580. 

In This Article

Abstract and Introduction

Abstract

Although chronic cough in adults (cough lasting longer than eight weeks) can be caused by many etiologies, four conditions account for most cases: upper airway cough syndrome, gastroesophageal reflux disease/laryngopharyngeal reflux disease, asthma, and nonasthmatic eosinophilic bronchitis. Patients should be evaluated clinically (with spirometry, if indicated), and empiric treatment should be initiated. Other potential causes include angiotensin-converting enzyme inhibitor use, environmental triggers, tobacco use, chronic obstructive pulmonary disease, and obstructive sleep apnea. Chest radiography can rule out concerning infectious, inflammatory, and malignant thoracic conditions. Patients with refractory chronic cough may warrant referral to a pulmonologist or otolaryngologist in addition to a trial of gabapentin, pregabalin, and/or speech therapy. In children, cough is considered chronic if present for more than four weeks. In children six to 14 years of age, it is most commonly caused by asthma, protracted bacterial bronchitis, and upper airway cough syndrome. Evaluation should focus initially on these etiologies, with targeted treatment and monitoring for resolution.

Introduction

Cough caused by the common cold typically lasts one to three weeks and is self-limited. However, persistent chronic cough can be the first sign of a more serious disease process. According to the Centers for Disease Control and Prevention, cough of undifferentiated duration is the most common presenting symptom in patients of all ages in the primary care ambulatory setting.[1] In adults, chronic cough is defined as symptoms lasting longer than eight weeks, whereas acute cough lasts less than three weeks and subacute cough from three to eight weeks.[2] When persistent and excessive, cough can seriously impair quality of life and lead to vomiting, muscle pain, rib fractures, urinary incontinence, tiredness, syncope, and depression. It also has psychosocial effects, such as embarrassment and negative impact on social interactions.[3] This article presents a systematic approach to the evaluation of chronic cough, derived from the results of prospective studies and an evidence-based practice guideline.[4,5]

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