Table of contents
Chronic cough
What's new
Updated 2024 AAFP guidelines for the management of chronic cough.
Background
Overview
Definition
Chronic cough is defined as a cough symptom that persists for longer than 8 weeks.
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Pathophysiology
Common causes of cough include upper airway cough syndrome, GERD/laryngopharyngeal reflux disease, asthma, and nonasthmatic eosinophilic bronchitis.
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Disease course
Cough persistence may lead to vomiting, muscle pain, urinary incontinence, tiredness, syncope, and depression.
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Prognosis and risk of recurrence
Chronic cough is not associated with an increase in mortality in the absence of a serious underlying disease.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of chronic cough are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024), the American College of Radiology (ACR 2021), the American College of Chest Physicians (ACCP 2020,2018,2016,2015), the British Thoracic Society (BTS 2020), and the European Respiratory Society (ERS 2020).
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Screening and diagnosis
Diagnosis of unexplained chronic cough: as per ACCP 2016 guidelines, define unexplained chronic cough as a cough that persists > 8 weeks, remains unexplained after investigation, and persists despite supervised therapeutic trial(s) conducted according to published best-practice guidelines in adult patients with chronic cough.
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Classification and risk stratification
Risk factors: as per ACCP 2020 guidelines, recognize that smoking and dusty environmental exposures, such as irritating inhalants and environmental pollutants, are risk factors for chronic cough due to chronic bronchitis in adult patients.
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VAS
Diagnostic investigations
Cough questionnaire assessment
As per ACCP 2015 guidelines:
Use validated and reliable health-related QoL questionnaires in adult and adolescent patients ≥ 14 years of age with complaints of chronic cough.
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Use the Cough-Specific Quality-of-Life Questionnaire and Leicester Cough Questionnaire in adult and adolescent patients with chronic cough, as they are the most extensively studied and commonly used questionnaires to assess the impact of cough.
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Acoustic cough counting
Tussigenic challenges
Chest imaging
Evaluation for bronchial hyperresponsiveness
Respiratory support
Medical management
General principles: as per AAFP 2024 guidelines, evaluate and manage adult patients with chronic cough based on the most common causes, including upper airway cough syndrome, asthma, nonasthmatic eosinophilic bronchitis, GERD, and laryngopharyngeal reflux.
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ICSs
Bronchodilators
Leukotriene receptor antagonists
Mucolytics
Gabapentinoids
Opioids
Acid suppression therapy
Antibiotics
Nonpharmacologic interventions
Specific circumstances
Pediatric patients, evaluation: as per AAFP 2024 guidelines, evaluate and manage pediatric patients with chronic cough based on the most common causes, including protracted bacterial bronchitis, asthma, bronchiectasis, upper airway cough syndrome, and GERD.
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Pediatric patients (management)
Patients with somatic or tic cough (diagnosis)
Patients with somatic or tic cough (management)
Patients with asthma
Patients with non-asthmatic eosinophilic bronchitis
Patients with ILD