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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 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

PEEP: as per ACCP 2020 guidelines, avoid offering PEEP to relieve cough in adult patients with cough due to stable chronic bronchitis.

Medical management

ICSs: as per ERS 2020 guidelines, consider offering a short-term trial (2-4 weeks) of ICSs in adult patients with chronic cough.
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  • Bronchodilators

  • Leukotriene receptor antagonists

  • Mucolytics

  • Gabapentinoids

  • Opioids

  • Acid suppression therapy

  • Antibiotics

Nonpharmacologic interventions

Speech therapy: as per ERS 2020 guidelines, consider offering a trial of cough control therapy in adult patients with chronic cough.
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Specific circumstances

Pediatric patients, evaluation: as per ACCP 2015 guidelines, use validated and reliable health-related QoL questionnaires in pediatric patients with chronic cough. (Grade 1B(.

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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