The Bottom Line: “Chronic cough, i.e., cough lasting longer than eight weeks, affects approximately 10% of the population and is a common reason for outpatient medical consultation. Its differential diagnosis is extensive, and it is generally evaluated in poorly structured fashion with a variety of diagnostic techniques.” “History-taking, after the exclusion of red flags, should include questioning about smoking status, medications, and relevant present and past illnesses (COPD, asthma). Subsequent diagnostic testing should include a chest x-ray and pulmonary function tests.” (Krüger)
“Algorithm for structured process in patients with chronic or refractory cough
ACE, angiotensin-converting enzyme; COPD, chronic obstructive pulmonary disease; CT, computed tomography; RKI, Robert Koch Institute”
Approach to Diagnosis
“Initial evaluation should proceed as follows:
Careful medical history and physical examination to identify an obvious cause or need for testing
Order chest radiography if not done in the last 6 months
Can consider waiting if a likely cause is identified and treated
Order chest CT if chest radiograph is abnormal or diagnoses such as lung cancer, bronchiectasis, or interstitial lung disease are being considered
Positive response to empiric treatment supports diagnosis of these more common causes of chronic cough:
Upper airway cough syndrome
Asthma
Gastroesophageal reflux disease
Nonasthmatic eosinophilic bronchitis
Avoid exposure to these cough triggers:
Smoking
Medications such as ACE inhibitors”
Krüger K, et al Collaborators. Chronic Cough. Dtsch Arztebl Int. 2022 Feb 4;119(5):59-65.Free Full Text
Elsevier Point of Care: Clinical Overview. Chronic Cough Released June 16, 2023
The Bottom Line 