Materiały źródłowe

• #1 Chronic cough – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-cough/diagnosis-treatment/drc-20351580

  Your healthcare professional asks about your medical history and does a physical exam. A thorough medical history and physical exam can give important clues about a chronic cough. Your health professional also may order tests to look for the cause of your chronic cough. […] But many health professionals start treatment for one of the common causes of chronic cough rather than ordering expensive tests. If the treatment doesn’t work, you may be tested for less common causes. […] A chest X-ray and spirometry, at a minimum, are usually ordered to find the cause of a chronic cough in children. […] Finding out what’s causing a chronic cough is very important to effective treatment. In many cases, more than one underlying condition may be causing your chronic cough. […] Your healthcare professional works to find the cause of your cough and the best treatment for you. During that time, your healthcare professional also may prescribe a medicine to reduce coughing, called a cough suppressant. Cough suppressants are not recommended for children.

• #2 Chronic Cough Symptoms and Diagnosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/chronic-cough/symptoms-diagnosis

  It’s important to keep in mind that a chronic cough lasts eight weeks or longer because this threshold makes it less likely that the cough is caused by a respiratory infection or common cold. […] Your healthcare provider will work with you to take a thorough history and physical exam to attempt to identify the cause of your chronic cough. […] A cough that lasts less than eight weeks is usually caused by a respiratory infection and will go away on its own. If you have developed a cough of any kind that goes on for longer than eight weeks, you should see your healthcare provider for a thorough exam to determine what is causing it. […] To identify the cause of your chronic cough, the doctor will ask questions about your medical history, do a physical exam and run some tests. […] Your healthcare provider may decide to order tests. Some diagnostic tests may need to be completed by a specialist besides your primary health care provider. The tests ordered may include: Chest X-ray: Quick and easy chest picture, Blood sample: To see if your body is fighting an infection or if there are signs of allergies, CT scan of the chest: A better-quality picture of the chest, Throat swab: Usually done with a long cotton swab, Phlegm or sputum sample: Collected after a deep cough, Spirometry: You will be asked to breathe out hard and fast into a small plastic device to measure how well you breathe out air, Methacholine challenge test: A breathing test often used to diagnose or rule out asthma.

• #3 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Initial evaluation of the patient with chronic cough (i.e., of more than eight weeks’ duration) should include a focused history and physical examination, and in most patients, chest radiography. […] The most common causes of chronic cough in adults are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, alone or in combination. […] The diagnosis of asthma should be confirmed based on clinical response to empiric therapy with inhaled bronchodilators or corticosteroids. […] Empiric treatment for gastroesophageal reflux disease should be initiated in lieu of testing for patients with chronic cough and reflux symptoms. […] Further testing, such as high-resolution computed tomography, and referral to a pulmonologist may be indicated if the cause of chronic cough is not identified.

• #4 Chronic cough – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-cough/diagnosis-treatment/drc-20351580

  Your healthcare professional asks about your medical history and does a physical exam. A thorough medical history and physical exam can give important clues about a chronic cough. Your health professional also may order tests to look for the cause of your chronic cough. […] But many health professionals start treatment for one of the common causes of chronic cough rather than ordering expensive tests. If the treatment doesn’t work, you may be tested for less common causes. […] A chest X-ray and spirometry, at a minimum, are usually ordered to find the cause of a chronic cough in children. […] Finding out what’s causing a chronic cough is very important to effective treatment. In many cases, more than one underlying condition may be causing your chronic cough. […] Your healthcare professional works to find the cause of your cough and the best treatment for you. During that time, your healthcare professional also may prescribe a medicine to reduce coughing, called a cough suppressant. Cough suppressants are not recommended for children.

• #5 Chronic cough – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-cough/diagnosis-treatment/drc-20351580

  Your healthcare professional asks about your medical history and does a physical exam. A thorough medical history and physical exam can give important clues about a chronic cough. Your health professional also may order tests to look for the cause of your chronic cough. […] But many health professionals start treatment for one of the common causes of chronic cough rather than ordering expensive tests. If the treatment doesn’t work, you may be tested for less common causes. […] A chest X-ray and spirometry, at a minimum, are usually ordered to find the cause of a chronic cough in children. […] Finding out what’s causing a chronic cough is very important to effective treatment. In many cases, more than one underlying condition may be causing your chronic cough. […] Your healthcare professional works to find the cause of your cough and the best treatment for you. During that time, your healthcare professional also may prescribe a medicine to reduce coughing, called a cough suppressant. Cough suppressants are not recommended for children.

• #6 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Initial evaluation of the patient with chronic cough (i.e., of more than eight weeks’ duration) should include a focused history and physical examination, and in most patients, chest radiography. […] The most common causes of chronic cough in adults are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, alone or in combination. […] The diagnosis of asthma should be confirmed based on clinical response to empiric therapy with inhaled bronchodilators or corticosteroids. […] Empiric treatment for gastroesophageal reflux disease should be initiated in lieu of testing for patients with chronic cough and reflux symptoms. […] Further testing, such as high-resolution computed tomography, and referral to a pulmonologist may be indicated if the cause of chronic cough is not identified.

• #7 Chronic cough – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-cough/diagnosis-treatment/drc-20351580

  Your healthcare professional may ask some of these questions: What are your symptoms and when did they begin? Did you recently have the flu or a cold? Do you smoke tobacco or have you ever smoked tobacco? Does anyone in your family or workplace smoke? Are you exposed to dust or chemicals at home or at work? Do you have heartburn? Do you cough up anything? If so, what does it look like? Do you take blood pressure medicine? If so, what type do you take? When does your cough occur? Does anything relieve your cough? What treatments have you tried? Do you get short of breath or wheeze when you move around or when exposed to cold air? What is your travel history?

• #8 Evaluation of chronic cough – Diagnosis Approach | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/69/diagnosis-approach

  In practice, diagnostic and therapeutic processes are often applied simultaneously. […] A detailed history is essential, and should include: Time and clinical setting of onset, Exacerbating factors, Associated symptoms, Prior history suggestive of atopic disease, A complete medical, smoking, drug, and exposure history, Occupational and family history, What measures have already been tried, and to what effect. […] The history substantially influences the clinician’s impression as to which (if any) of the four most common etiologies (upper airway cough syndrome [UACS], asthma, gastroesophageal reflux disease [GERD], or nonasthmatic eosinophilic bronchitis [NAEB]) are most likely. […] A careful examination is, unfortunately, unlikely to inform the clinician regarding the commonest causes of chronic cough, but is essential for early detection of less common causes, such as bronchiectasis, interstitial lung disease, neoplastic disorders, or chronic infectious pulmonary diseases.

• #9 Evaluation of chronic cough – Diagnosis Approach | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/69/diagnosis-approach

  In practice, diagnostic and therapeutic processes are often applied simultaneously. […] A detailed history is essential, and should include: Time and clinical setting of onset, Exacerbating factors, Associated symptoms, Prior history suggestive of atopic disease, A complete medical, smoking, drug, and exposure history, Occupational and family history, What measures have already been tried, and to what effect. […] The history substantially influences the clinician’s impression as to which (if any) of the four most common etiologies (upper airway cough syndrome [UACS], asthma, gastroesophageal reflux disease [GERD], or nonasthmatic eosinophilic bronchitis [NAEB]) are most likely. […] A careful examination is, unfortunately, unlikely to inform the clinician regarding the commonest causes of chronic cough, but is essential for early detection of less common causes, such as bronchiectasis, interstitial lung disease, neoplastic disorders, or chronic infectious pulmonary diseases.

• #10 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Initial evaluation of the patient with chronic cough (i.e., of more than eight weeks’ duration) should include a focused history and physical examination, and in most patients, chest radiography. […] The most common causes of chronic cough in adults are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, alone or in combination. […] The diagnosis of asthma should be confirmed based on clinical response to empiric therapy with inhaled bronchodilators or corticosteroids. […] Empiric treatment for gastroesophageal reflux disease should be initiated in lieu of testing for patients with chronic cough and reflux symptoms. […] Further testing, such as high-resolution computed tomography, and referral to a pulmonologist may be indicated if the cause of chronic cough is not identified.

• #11 Evaluation of chronic cough – Diagnosis Approach | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/69/diagnosis-approach

  Although no specific history or physical exam findings are reliably associated with specific etiology of chronic cough, they may direct further testing or therapeutic trials. […] The symptoms and findings associated with the common causes (asthma, UACS, GERD, or NAEB) may direct further diagnostic evaluation toward confirming that cause. […] A chest x-ray should be obtained early in the evaluation of chronic cough. […] Although it is not diagnostic of the most common causes, findings may quickly divert the evaluation to causes of greater gravity, such as structural lung diseases. […] Following chest x-ray, the choice of either diagnostic testing or therapeutic trials depends on the clinician’s assessed probability of a specific etiology and the patient’s preferred approach. […] Unless the history, physical examination, and chest x-ray indicate otherwise, efforts should be concentrated on one or more of the four most common causes (asthma, UACS, GERD, NAEB).

• #12 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Empiric treatment should be initiated sequentially for the three most common causes of chronic cough until symptoms are resolved. […] Normal chest radiography usually excludes bronchiectasis, persistent pneumonia, sarcoidosis, and tuberculosis. […] A diagnosis of UACS can also be made after a trial of therapy. […] Asthma is the next most common cause of chronic cough in adults. […] Cough is the most commonly reported symptom in patients with chronic asthma, and it is the only manifestation in up to 57 percent (i.e., cough-variant asthma). […] GERD is the third leading cause of chronic cough in adults. […] A definitive diagnosis of GERD-related cough requires that the cough nearly or completely disappears with treatment. […] ACE inhibitors cause a nonproductive cough in 5 to 20 percent of patients, affecting women more often than men.

• #13

  https://link.springer.com/article/10.1007/s41030-019-0089-7

  The diagnostic test is a nasopharyngeal swab with a special medium as the organism is quite difficult to grow. […] There is a 92% probability, based on prospective trials, that in patients who have been treated unsuccessfully for UACS, asthma, and NAEB, not on an ACE and with a normal CXR, that their chronic cough is due to GERD. […] Spirometry is the gold standard to diagnose asthma and COPD, but false positives can exist with some conditions that can cause confusion. […] An abnormal chest radiograph will define the further workup needed, depending on the specific findings. Chest CT scan, bronchoscopy, needle biopsy, and sputum studies are all potential next steps if a pulmonary lesion is found. […] The use of an algorithmic approach such as the ACCP guidelines can give you a roadmap to making the diagnosis. It is tempting to just try ICS, but in the absence of evidence of eosinophilic inflammation, this should be avoided. Go to the effort of making a firm diagnosis, most often one of the big three of UACS, GERD, or asthma, especially in those without any red flags and your success of treatment will be much higher.

• #14 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Initial evaluation of the patient with chronic cough (i.e., of more than eight weeks’ duration) should include a focused history and physical examination, and in most patients, chest radiography. […] The most common causes of chronic cough in adults are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, alone or in combination. […] The diagnosis of asthma should be confirmed based on clinical response to empiric therapy with inhaled bronchodilators or corticosteroids. […] Empiric treatment for gastroesophageal reflux disease should be initiated in lieu of testing for patients with chronic cough and reflux symptoms. […] Further testing, such as high-resolution computed tomography, and referral to a pulmonologist may be indicated if the cause of chronic cough is not identified.

• #15 Chronic Cough – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430791/

  Cough can be divided into 3 types based on the duration of symptoms: acute, subacute, and chronic cough. Chronic cough is a persistent cough that lasts 8 weeks or longer in adults, while subacute cough usually lasts 3 to 8 weeks, and acute cough typically lasts for less than 3 weeks. Chronic cough is a widespread yet underappreciated condition that imposes substantial illness on affected individuals. […] This activity will focus on chronic cough, a common respiratory symptom for apparent and covert diseases that can significantly impact the quality of life and contribute to a diagnostic dilemma for physicians. […] Diagnosing cough-variant asthma may involve pulmonary function tests, such as spirometry, to assess how well the lungs function. […] The lack of airflow limitation on spirometry distinguishes NAEB from asthma.

• #16 Chronic cough – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-cough/diagnosis-treatment/drc-20351580

  Your healthcare professional asks about your medical history and does a physical exam. A thorough medical history and physical exam can give important clues about a chronic cough. Your health professional also may order tests to look for the cause of your chronic cough. […] But many health professionals start treatment for one of the common causes of chronic cough rather than ordering expensive tests. If the treatment doesn’t work, you may be tested for less common causes. […] A chest X-ray and spirometry, at a minimum, are usually ordered to find the cause of a chronic cough in children. […] Finding out what’s causing a chronic cough is very important to effective treatment. In many cases, more than one underlying condition may be causing your chronic cough. […] Your healthcare professional works to find the cause of your cough and the best treatment for you. During that time, your healthcare professional also may prescribe a medicine to reduce coughing, called a cough suppressant. Cough suppressants are not recommended for children.

• #17

  https://link.springer.com/article/10.1007/s41030-019-0089-7

  The diagnostic test is a nasopharyngeal swab with a special medium as the organism is quite difficult to grow. […] There is a 92% probability, based on prospective trials, that in patients who have been treated unsuccessfully for UACS, asthma, and NAEB, not on an ACE and with a normal CXR, that their chronic cough is due to GERD. […] Spirometry is the gold standard to diagnose asthma and COPD, but false positives can exist with some conditions that can cause confusion. […] An abnormal chest radiograph will define the further workup needed, depending on the specific findings. Chest CT scan, bronchoscopy, needle biopsy, and sputum studies are all potential next steps if a pulmonary lesion is found. […] The use of an algorithmic approach such as the ACCP guidelines can give you a roadmap to making the diagnosis. It is tempting to just try ICS, but in the absence of evidence of eosinophilic inflammation, this should be avoided. Go to the effort of making a firm diagnosis, most often one of the big three of UACS, GERD, or asthma, especially in those without any red flags and your success of treatment will be much higher.

• #18 Cough: Causes, Diagnosis, Treatment & Conditions

  https://my.clevelandclinic.org/health/symptoms/17755-cough

  Chronic cough lasts longer than eight weeks. Long-lasting coughs may also be called persistent coughs. […] Medical conditions that can cause chronic cough include chronic bronchitis, asthma, allergies, chronic obstructive pulmonary disease (COPD) and other lung conditions, gastroesophageal reflux disease (GERD), throat disorders, including vocal cord disorders, postnasal drip, and heart failure and other cardiac conditions. […] To diagnose what’s behind your cough, your healthcare provider will take a medical history, give you a physical exam, and may order some tests. As part of the exam, your provider will check your vital signs, like temperature and the number of breaths you take. They might check your oxygen levels, do a spirometry test in the office, or order a chest X-ray or lung function tests if your cough has lasted a long time.

• #19 Chronic Cough Symptoms and Diagnosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/chronic-cough/symptoms-diagnosis

  It’s important to keep in mind that a chronic cough lasts eight weeks or longer because this threshold makes it less likely that the cough is caused by a respiratory infection or common cold. […] Your healthcare provider will work with you to take a thorough history and physical exam to attempt to identify the cause of your chronic cough. […] A cough that lasts less than eight weeks is usually caused by a respiratory infection and will go away on its own. If you have developed a cough of any kind that goes on for longer than eight weeks, you should see your healthcare provider for a thorough exam to determine what is causing it. […] To identify the cause of your chronic cough, the doctor will ask questions about your medical history, do a physical exam and run some tests. […] Your healthcare provider may decide to order tests. Some diagnostic tests may need to be completed by a specialist besides your primary health care provider. The tests ordered may include: Chest X-ray: Quick and easy chest picture, Blood sample: To see if your body is fighting an infection or if there are signs of allergies, CT scan of the chest: A better-quality picture of the chest, Throat swab: Usually done with a long cotton swab, Phlegm or sputum sample: Collected after a deep cough, Spirometry: You will be asked to breathe out hard and fast into a small plastic device to measure how well you breathe out air, Methacholine challenge test: A breathing test often used to diagnose or rule out asthma.

• #20 Chronic Cough: Practice Essentials, Mechanism of Cough, Causes of Chronic Cough

  https://emedicine.medscape.com/article/1048560-overview

  Every patient with chronic cough needs a thorough history taken and physical examination performed as part of their evaluation. Each patient should also have a chest radiograph taken. […] Workup also includes the following: Upper airway cough syndrome (UACS) – Workup may include allergy testing for allergic rhinitis or sinus CT scanning for sinusitis, as indicated; Asthma – Ideally, patients should undergo spirometry and bronchoprovocation challenge with methacholine, which reveals reversible airflow obstruction; Nonallergic eosinophilic bronchitis (NAEB) – An induced sputum test that reveals increased eosinophils is the diagnostic procedure of choice; Gastroesophageal reflux disease (GERD) – The criterion standard for diagnosis of GERD is dual-channel 24-hour pH probe monitoring; alternatively, flexible nasopharyngoscopy can reveal glottic changes associated with reflux; however, testing is reserved for refractory cases; Refractory chronic cough – Only when management of the most common causes has failed to yield a resolution of cough should a more extensive workup begin; this can include induced sputum testing for acid-fast bacillus, high-resolution CT scanning of the chest, and bronchoscopy.

• #21 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Initial evaluation of the patient with chronic cough (i.e., of more than eight weeks’ duration) should include a focused history and physical examination, and in most patients, chest radiography. […] The most common causes of chronic cough in adults are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, alone or in combination. […] The diagnosis of asthma should be confirmed based on clinical response to empiric therapy with inhaled bronchodilators or corticosteroids. […] Empiric treatment for gastroesophageal reflux disease should be initiated in lieu of testing for patients with chronic cough and reflux symptoms. […] Further testing, such as high-resolution computed tomography, and referral to a pulmonologist may be indicated if the cause of chronic cough is not identified.

• #22 Chronic Cough: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1101/p575.html

  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. […] 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. […] The diagnostic approach should focus on detection and treatment of the four most common causes of chronic cough in adults: upper airway cough syndrome (UACS), asthma, nonasthmatic eosinophilic bronchitis, and gastroesophageal reflux disease (GERD)/laryngopharyngeal reflux disease.

• #23 Chronic Cough: Practice Essentials, Mechanism of Cough, Causes of Chronic Cough

  https://emedicine.medscape.com/article/1048560-overview

  Every patient with chronic cough needs a thorough history taken and physical examination performed as part of their evaluation. Each patient should also have a chest radiograph taken. […] Workup also includes the following: Upper airway cough syndrome (UACS) – Workup may include allergy testing for allergic rhinitis or sinus CT scanning for sinusitis, as indicated; Asthma – Ideally, patients should undergo spirometry and bronchoprovocation challenge with methacholine, which reveals reversible airflow obstruction; Nonallergic eosinophilic bronchitis (NAEB) – An induced sputum test that reveals increased eosinophils is the diagnostic procedure of choice; Gastroesophageal reflux disease (GERD) – The criterion standard for diagnosis of GERD is dual-channel 24-hour pH probe monitoring; alternatively, flexible nasopharyngoscopy can reveal glottic changes associated with reflux; however, testing is reserved for refractory cases; Refractory chronic cough – Only when management of the most common causes has failed to yield a resolution of cough should a more extensive workup begin; this can include induced sputum testing for acid-fast bacillus, high-resolution CT scanning of the chest, and bronchoscopy.

• #24 Chronic Cough: Practice Essentials, Mechanism of Cough, Causes of Chronic Cough

  https://emedicine.medscape.com/article/1048560-overview

  Every patient with chronic cough needs a thorough history taken and physical examination performed as part of their evaluation. Each patient should also have a chest radiograph taken. […] Workup also includes the following: Upper airway cough syndrome (UACS) – Workup may include allergy testing for allergic rhinitis or sinus CT scanning for sinusitis, as indicated; Asthma – Ideally, patients should undergo spirometry and bronchoprovocation challenge with methacholine, which reveals reversible airflow obstruction; Nonallergic eosinophilic bronchitis (NAEB) – An induced sputum test that reveals increased eosinophils is the diagnostic procedure of choice; Gastroesophageal reflux disease (GERD) – The criterion standard for diagnosis of GERD is dual-channel 24-hour pH probe monitoring; alternatively, flexible nasopharyngoscopy can reveal glottic changes associated with reflux; however, testing is reserved for refractory cases; Refractory chronic cough – Only when management of the most common causes has failed to yield a resolution of cough should a more extensive workup begin; this can include induced sputum testing for acid-fast bacillus, high-resolution CT scanning of the chest, and bronchoscopy.

• #25 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Empiric treatment should be initiated sequentially for the three most common causes of chronic cough until symptoms are resolved. […] Normal chest radiography usually excludes bronchiectasis, persistent pneumonia, sarcoidosis, and tuberculosis. […] A diagnosis of UACS can also be made after a trial of therapy. […] Asthma is the next most common cause of chronic cough in adults. […] Cough is the most commonly reported symptom in patients with chronic asthma, and it is the only manifestation in up to 57 percent (i.e., cough-variant asthma). […] GERD is the third leading cause of chronic cough in adults. […] A definitive diagnosis of GERD-related cough requires that the cough nearly or completely disappears with treatment. […] ACE inhibitors cause a nonproductive cough in 5 to 20 percent of patients, affecting women more often than men.

• #26 Evaluation of chronic cough – Diagnosis Approach | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/69/diagnosis-approach

  If none of the four most common causes seem likely after thorough assessment, other tests to consider include: High-resolution CT imaging of the chest to look for bronchiectasis, foreign body aspiration, pulmonary fibrosis, or other structural lung disease. […] If UACS is suspected, a therapeutic trial aimed at resolving rhinosinusitis and reducing excessive secretions is indicated. […] A therapeutic trial of proton pump inhibitors (PPIs) is recommended for patients with typical GERD symptoms (heartburn and regurgitation). […] Diagnostic testing (including esophageal pH monitoring and endoscopy) may be considered according to clinician or patient preference in those refractory to a therapeutic trial of PPIs, or where there is a strong clinical suspicion of reflux-related cough. […] Therapeutic trials are selected based on clinical impression, at times supported by diagnostic testing.

• #27 Chronic Cough: Practice Essentials, Mechanism of Cough, Causes of Chronic Cough

  https://emedicine.medscape.com/article/1048560-overview

  Every patient with chronic cough needs a thorough history taken and physical examination performed as part of their evaluation. Each patient should also have a chest radiograph taken. […] Workup also includes the following: Upper airway cough syndrome (UACS) – Workup may include allergy testing for allergic rhinitis or sinus CT scanning for sinusitis, as indicated; Asthma – Ideally, patients should undergo spirometry and bronchoprovocation challenge with methacholine, which reveals reversible airflow obstruction; Nonallergic eosinophilic bronchitis (NAEB) – An induced sputum test that reveals increased eosinophils is the diagnostic procedure of choice; Gastroesophageal reflux disease (GERD) – The criterion standard for diagnosis of GERD is dual-channel 24-hour pH probe monitoring; alternatively, flexible nasopharyngoscopy can reveal glottic changes associated with reflux; however, testing is reserved for refractory cases; Refractory chronic cough – Only when management of the most common causes has failed to yield a resolution of cough should a more extensive workup begin; this can include induced sputum testing for acid-fast bacillus, high-resolution CT scanning of the chest, and bronchoscopy.

• #28 Chronic Cough: Practice Essentials, Mechanism of Cough, Causes of Chronic Cough

  https://emedicine.medscape.com/article/1048560-overview

  Every patient with chronic cough needs a thorough history taken and physical examination performed as part of their evaluation. Each patient should also have a chest radiograph taken. […] Workup also includes the following: Upper airway cough syndrome (UACS) – Workup may include allergy testing for allergic rhinitis or sinus CT scanning for sinusitis, as indicated; Asthma – Ideally, patients should undergo spirometry and bronchoprovocation challenge with methacholine, which reveals reversible airflow obstruction; Nonallergic eosinophilic bronchitis (NAEB) – An induced sputum test that reveals increased eosinophils is the diagnostic procedure of choice; Gastroesophageal reflux disease (GERD) – The criterion standard for diagnosis of GERD is dual-channel 24-hour pH probe monitoring; alternatively, flexible nasopharyngoscopy can reveal glottic changes associated with reflux; however, testing is reserved for refractory cases; Refractory chronic cough – Only when management of the most common causes has failed to yield a resolution of cough should a more extensive workup begin; this can include induced sputum testing for acid-fast bacillus, high-resolution CT scanning of the chest, and bronchoscopy.

• #29 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Initial evaluation of the patient with chronic cough (i.e., of more than eight weeks’ duration) should include a focused history and physical examination, and in most patients, chest radiography. […] The most common causes of chronic cough in adults are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, alone or in combination. […] The diagnosis of asthma should be confirmed based on clinical response to empiric therapy with inhaled bronchodilators or corticosteroids. […] Empiric treatment for gastroesophageal reflux disease should be initiated in lieu of testing for patients with chronic cough and reflux symptoms. […] Further testing, such as high-resolution computed tomography, and referral to a pulmonologist may be indicated if the cause of chronic cough is not identified.

• #30 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Empiric treatment should be initiated sequentially for the three most common causes of chronic cough until symptoms are resolved. […] Normal chest radiography usually excludes bronchiectasis, persistent pneumonia, sarcoidosis, and tuberculosis. […] A diagnosis of UACS can also be made after a trial of therapy. […] Asthma is the next most common cause of chronic cough in adults. […] Cough is the most commonly reported symptom in patients with chronic asthma, and it is the only manifestation in up to 57 percent (i.e., cough-variant asthma). […] GERD is the third leading cause of chronic cough in adults. […] A definitive diagnosis of GERD-related cough requires that the cough nearly or completely disappears with treatment. […] ACE inhibitors cause a nonproductive cough in 5 to 20 percent of patients, affecting women more often than men.

• #31 Chronic Cough: Practice Essentials, Mechanism of Cough, Causes of Chronic Cough

  https://emedicine.medscape.com/article/1048560-overview

  Every patient with chronic cough needs a thorough history taken and physical examination performed as part of their evaluation. Each patient should also have a chest radiograph taken. […] Workup also includes the following: Upper airway cough syndrome (UACS) – Workup may include allergy testing for allergic rhinitis or sinus CT scanning for sinusitis, as indicated; Asthma – Ideally, patients should undergo spirometry and bronchoprovocation challenge with methacholine, which reveals reversible airflow obstruction; Nonallergic eosinophilic bronchitis (NAEB) – An induced sputum test that reveals increased eosinophils is the diagnostic procedure of choice; Gastroesophageal reflux disease (GERD) – The criterion standard for diagnosis of GERD is dual-channel 24-hour pH probe monitoring; alternatively, flexible nasopharyngoscopy can reveal glottic changes associated with reflux; however, testing is reserved for refractory cases; Refractory chronic cough – Only when management of the most common causes has failed to yield a resolution of cough should a more extensive workup begin; this can include induced sputum testing for acid-fast bacillus, high-resolution CT scanning of the chest, and bronchoscopy.

• #32 Chronic Cough: Practice Essentials, Mechanism of Cough, Causes of Chronic Cough

  https://emedicine.medscape.com/article/1048560-overview

  Every patient with chronic cough needs a thorough history taken and physical examination performed as part of their evaluation. Each patient should also have a chest radiograph taken. […] Workup also includes the following: Upper airway cough syndrome (UACS) – Workup may include allergy testing for allergic rhinitis or sinus CT scanning for sinusitis, as indicated; Asthma – Ideally, patients should undergo spirometry and bronchoprovocation challenge with methacholine, which reveals reversible airflow obstruction; Nonallergic eosinophilic bronchitis (NAEB) – An induced sputum test that reveals increased eosinophils is the diagnostic procedure of choice; Gastroesophageal reflux disease (GERD) – The criterion standard for diagnosis of GERD is dual-channel 24-hour pH probe monitoring; alternatively, flexible nasopharyngoscopy can reveal glottic changes associated with reflux; however, testing is reserved for refractory cases; Refractory chronic cough – Only when management of the most common causes has failed to yield a resolution of cough should a more extensive workup begin; this can include induced sputum testing for acid-fast bacillus, high-resolution CT scanning of the chest, and bronchoscopy.

• #33 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Initial evaluation of the patient with chronic cough (i.e., of more than eight weeks’ duration) should include a focused history and physical examination, and in most patients, chest radiography. […] The most common causes of chronic cough in adults are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, alone or in combination. […] The diagnosis of asthma should be confirmed based on clinical response to empiric therapy with inhaled bronchodilators or corticosteroids. […] Empiric treatment for gastroesophageal reflux disease should be initiated in lieu of testing for patients with chronic cough and reflux symptoms. […] Further testing, such as high-resolution computed tomography, and referral to a pulmonologist may be indicated if the cause of chronic cough is not identified.

• #34 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Empiric treatment should be initiated sequentially for the three most common causes of chronic cough until symptoms are resolved. […] Normal chest radiography usually excludes bronchiectasis, persistent pneumonia, sarcoidosis, and tuberculosis. […] A diagnosis of UACS can also be made after a trial of therapy. […] Asthma is the next most common cause of chronic cough in adults. […] Cough is the most commonly reported symptom in patients with chronic asthma, and it is the only manifestation in up to 57 percent (i.e., cough-variant asthma). […] GERD is the third leading cause of chronic cough in adults. […] A definitive diagnosis of GERD-related cough requires that the cough nearly or completely disappears with treatment. […] ACE inhibitors cause a nonproductive cough in 5 to 20 percent of patients, affecting women more often than men.

• #35 Chronic Cough: Practice Essentials, Mechanism of Cough, Causes of Chronic Cough

  https://emedicine.medscape.com/article/1048560-overview

  Every patient with chronic cough needs a thorough history taken and physical examination performed as part of their evaluation. Each patient should also have a chest radiograph taken. […] Workup also includes the following: Upper airway cough syndrome (UACS) – Workup may include allergy testing for allergic rhinitis or sinus CT scanning for sinusitis, as indicated; Asthma – Ideally, patients should undergo spirometry and bronchoprovocation challenge with methacholine, which reveals reversible airflow obstruction; Nonallergic eosinophilic bronchitis (NAEB) – An induced sputum test that reveals increased eosinophils is the diagnostic procedure of choice; Gastroesophageal reflux disease (GERD) – The criterion standard for diagnosis of GERD is dual-channel 24-hour pH probe monitoring; alternatively, flexible nasopharyngoscopy can reveal glottic changes associated with reflux; however, testing is reserved for refractory cases; Refractory chronic cough – Only when management of the most common causes has failed to yield a resolution of cough should a more extensive workup begin; this can include induced sputum testing for acid-fast bacillus, high-resolution CT scanning of the chest, and bronchoscopy.

• #36 Chronic Cough – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430791/

  Cough can be divided into 3 types based on the duration of symptoms: acute, subacute, and chronic cough. Chronic cough is a persistent cough that lasts 8 weeks or longer in adults, while subacute cough usually lasts 3 to 8 weeks, and acute cough typically lasts for less than 3 weeks. Chronic cough is a widespread yet underappreciated condition that imposes substantial illness on affected individuals. […] This activity will focus on chronic cough, a common respiratory symptom for apparent and covert diseases that can significantly impact the quality of life and contribute to a diagnostic dilemma for physicians. […] Diagnosing cough-variant asthma may involve pulmonary function tests, such as spirometry, to assess how well the lungs function. […] The lack of airflow limitation on spirometry distinguishes NAEB from asthma.

• #37 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Empiric treatment should be initiated sequentially for the three most common causes of chronic cough until symptoms are resolved. […] Normal chest radiography usually excludes bronchiectasis, persistent pneumonia, sarcoidosis, and tuberculosis. […] A diagnosis of UACS can also be made after a trial of therapy. […] Asthma is the next most common cause of chronic cough in adults. […] Cough is the most commonly reported symptom in patients with chronic asthma, and it is the only manifestation in up to 57 percent (i.e., cough-variant asthma). […] GERD is the third leading cause of chronic cough in adults. […] A definitive diagnosis of GERD-related cough requires that the cough nearly or completely disappears with treatment. […] ACE inhibitors cause a nonproductive cough in 5 to 20 percent of patients, affecting women more often than men.

• #38 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Understanding-Chronic-Cough-Causes-Symptoms-and-Diagnosis.aspx

  Chronic cough differs from acute cough, characterized as having a known cause that can be eliminated by managing the underlying cause. Chronic cough, however, is the only symptom, and there is no clear presence of a disease etiology. Chronic cough is characterized as a cough that lasts more than eight weeks. It can produce marked suffering for patients and present a diagnostic problem for clinicians when the disease is not apparent. […] The duration of a cough at presentation can help healthcare practitioners diagnose a chronic cough. This occurs in cases where the cough has persisted for over eight weeks. As chronic cough may be caused by several disorders, as outlined previously, healthcare practitioners must assess whether the patient has clinical features of these diseases. […] In the absence of any 'red flag’ symptoms in the initial examination, smokers may be subject to initial investigation chest X-ray (CXR) and spirometry. Smokers are advised to stop smoking. For non-smokers taking an ACE inhibitor, this may be replaced or stopped. ACE inhibitor-induced cough improves within four weeks with cessation; if not, physicians may consider CXR and spirometry.

• #39 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Nonasthmatic eosinophilic bronchitis has been increasingly identified in patients presenting to pulmonary medicine clinics. […] Postinfectious cough should be considered when cough persists after an upper respiratory tract infection. […] Chronic bronchitis caused by exposure to cigarette smoke or other irritants is an important cause of chronic cough. […] A habitual cough is a diagnosis of exclusion. […] If chest radiography reveals abnormalities, further tests may be required to establish a diagnosis. […] Tuberculosis should be considered in patients with chronic cough who have sputum production, hemoptysis, fever, or weight loss and who live in areas with a high prevalence of the disease. […] Sarcoidosis is another less common cause of chronic cough. […] In children, a cough lasting longer than four weeks is considered chronic. […] The pathway recommended for investigating chronic cough in adults is not suitable for children younger than 15 years. […] Children with chronic cough should undergo chest radiography and spirometry, at minimum.

• #40 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Nonasthmatic eosinophilic bronchitis has been increasingly identified in patients presenting to pulmonary medicine clinics. […] Postinfectious cough should be considered when cough persists after an upper respiratory tract infection. […] Chronic bronchitis caused by exposure to cigarette smoke or other irritants is an important cause of chronic cough. […] A habitual cough is a diagnosis of exclusion. […] If chest radiography reveals abnormalities, further tests may be required to establish a diagnosis. […] Tuberculosis should be considered in patients with chronic cough who have sputum production, hemoptysis, fever, or weight loss and who live in areas with a high prevalence of the disease. […] Sarcoidosis is another less common cause of chronic cough. […] In children, a cough lasting longer than four weeks is considered chronic. […] The pathway recommended for investigating chronic cough in adults is not suitable for children younger than 15 years. […] Children with chronic cough should undergo chest radiography and spirometry, at minimum.

• #41 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Nonasthmatic eosinophilic bronchitis has been increasingly identified in patients presenting to pulmonary medicine clinics. […] Postinfectious cough should be considered when cough persists after an upper respiratory tract infection. […] Chronic bronchitis caused by exposure to cigarette smoke or other irritants is an important cause of chronic cough. […] A habitual cough is a diagnosis of exclusion. […] If chest radiography reveals abnormalities, further tests may be required to establish a diagnosis. […] Tuberculosis should be considered in patients with chronic cough who have sputum production, hemoptysis, fever, or weight loss and who live in areas with a high prevalence of the disease. […] Sarcoidosis is another less common cause of chronic cough. […] In children, a cough lasting longer than four weeks is considered chronic. […] The pathway recommended for investigating chronic cough in adults is not suitable for children younger than 15 years. […] Children with chronic cough should undergo chest radiography and spirometry, at minimum.

• #42 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Nonasthmatic eosinophilic bronchitis has been increasingly identified in patients presenting to pulmonary medicine clinics. […] Postinfectious cough should be considered when cough persists after an upper respiratory tract infection. […] Chronic bronchitis caused by exposure to cigarette smoke or other irritants is an important cause of chronic cough. […] A habitual cough is a diagnosis of exclusion. […] If chest radiography reveals abnormalities, further tests may be required to establish a diagnosis. […] Tuberculosis should be considered in patients with chronic cough who have sputum production, hemoptysis, fever, or weight loss and who live in areas with a high prevalence of the disease. […] Sarcoidosis is another less common cause of chronic cough. […] In children, a cough lasting longer than four weeks is considered chronic. […] The pathway recommended for investigating chronic cough in adults is not suitable for children younger than 15 years. […] Children with chronic cough should undergo chest radiography and spirometry, at minimum.

• #43 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Nonasthmatic eosinophilic bronchitis has been increasingly identified in patients presenting to pulmonary medicine clinics. […] Postinfectious cough should be considered when cough persists after an upper respiratory tract infection. […] Chronic bronchitis caused by exposure to cigarette smoke or other irritants is an important cause of chronic cough. […] A habitual cough is a diagnosis of exclusion. […] If chest radiography reveals abnormalities, further tests may be required to establish a diagnosis. […] Tuberculosis should be considered in patients with chronic cough who have sputum production, hemoptysis, fever, or weight loss and who live in areas with a high prevalence of the disease. […] Sarcoidosis is another less common cause of chronic cough. […] In children, a cough lasting longer than four weeks is considered chronic. […] The pathway recommended for investigating chronic cough in adults is not suitable for children younger than 15 years. […] Children with chronic cough should undergo chest radiography and spirometry, at minimum.

• #44 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  In children, a cough lasting longer than four weeks is considered chronic. […] The most common causes in children are respiratory tract infections, asthma, and gastroesophageal reflux disease. […] Evaluation of children with chronic cough should include chest radiography and spirometry. […] Chronic cough can be associated with significant distress and impairment in quality of life. […] This article presents a systematic approach to the evaluation of chronic cough based on the results of prospective studies and an evidence-based practice guideline. […] Most episodes of chronic cough in adults are caused by upper airway cough syndrome (UACS, also known as postnasal drip syndrome), asthma, or gastroesophageal reflux disease (GERD), alone or in combination. […] Chronic cough has two or more causes in 18 to 62 percent of patients, and three causes in up to 42 percent of patients.

• #45 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Nonasthmatic eosinophilic bronchitis has been increasingly identified in patients presenting to pulmonary medicine clinics. […] Postinfectious cough should be considered when cough persists after an upper respiratory tract infection. […] Chronic bronchitis caused by exposure to cigarette smoke or other irritants is an important cause of chronic cough. […] A habitual cough is a diagnosis of exclusion. […] If chest radiography reveals abnormalities, further tests may be required to establish a diagnosis. […] Tuberculosis should be considered in patients with chronic cough who have sputum production, hemoptysis, fever, or weight loss and who live in areas with a high prevalence of the disease. […] Sarcoidosis is another less common cause of chronic cough. […] In children, a cough lasting longer than four weeks is considered chronic. […] The pathway recommended for investigating chronic cough in adults is not suitable for children younger than 15 years. […] Children with chronic cough should undergo chest radiography and spirometry, at minimum.

• #46 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Initial evaluation of the patient with chronic cough (i.e., of more than eight weeks’ duration) should include a focused history and physical examination, and in most patients, chest radiography. […] The most common causes of chronic cough in adults are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, alone or in combination. […] The diagnosis of asthma should be confirmed based on clinical response to empiric therapy with inhaled bronchodilators or corticosteroids. […] Empiric treatment for gastroesophageal reflux disease should be initiated in lieu of testing for patients with chronic cough and reflux symptoms. […] Further testing, such as high-resolution computed tomography, and referral to a pulmonologist may be indicated if the cause of chronic cough is not identified.

• #47 Chronic cough – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-cough/diagnosis-treatment/drc-20351580

  Your healthcare professional asks about your medical history and does a physical exam. A thorough medical history and physical exam can give important clues about a chronic cough. Your health professional also may order tests to look for the cause of your chronic cough. […] But many health professionals start treatment for one of the common causes of chronic cough rather than ordering expensive tests. If the treatment doesn’t work, you may be tested for less common causes. […] A chest X-ray and spirometry, at a minimum, are usually ordered to find the cause of a chronic cough in children. […] Finding out what’s causing a chronic cough is very important to effective treatment. In many cases, more than one underlying condition may be causing your chronic cough. […] Your healthcare professional works to find the cause of your cough and the best treatment for you. During that time, your healthcare professional also may prescribe a medicine to reduce coughing, called a cough suppressant. Cough suppressants are not recommended for children.

• #48 Evaluation of chronic cough – Diagnosis Approach | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/69/diagnosis-approach

  Patients may present with a subacute cough, most commonly postinfection; however, in most patients, postinfectious cough is self-limited. […] Once the cough persists for longer than 8 weeks, further evaluation is indicated. […] Several validated tools of cough assessment are available, although these are used mostly for research purposes. […] Pursuing the cause and resolution of chronic cough requires ongoing commitment to the patient. […] The approach to an individual patient with chronic cough may vary from full initial diagnostic evaluation for common associated diseases, to empiric but targeted therapy for common conditions known to cause chronic cough, with limited or no diagnostic efforts. […] Choice of the specific approach may be individualized, and depends on type and duration of symptoms, the patient’s preference, and availability of resources.

• #49 Evaluation of chronic cough – Diagnosis Approach | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/69/diagnosis-approach

  In practice, diagnostic and therapeutic processes are often applied simultaneously. […] A detailed history is essential, and should include: Time and clinical setting of onset, Exacerbating factors, Associated symptoms, Prior history suggestive of atopic disease, A complete medical, smoking, drug, and exposure history, Occupational and family history, What measures have already been tried, and to what effect. […] The history substantially influences the clinician’s impression as to which (if any) of the four most common etiologies (upper airway cough syndrome [UACS], asthma, gastroesophageal reflux disease [GERD], or nonasthmatic eosinophilic bronchitis [NAEB]) are most likely. […] A careful examination is, unfortunately, unlikely to inform the clinician regarding the commonest causes of chronic cough, but is essential for early detection of less common causes, such as bronchiectasis, interstitial lung disease, neoplastic disorders, or chronic infectious pulmonary diseases.

• #50 Evaluation of chronic cough – Diagnosis Approach | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/69/diagnosis-approach

  The patient’s response to the trial must be assessed and the cough resolved before a given etiology may be assigned with certainty. […] A partial response may indicate that more than one etiology is in play. […] In this event, further testing and/or additional therapeutic trials may be indicated, while the partially successful therapy should be continued. […] Lack of a response requires reassessment both of suspected etiology and of treatment adherence and effectiveness.

• #51 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  Initial evaluation of the patient with chronic cough (i.e., of more than eight weeks’ duration) should include a focused history and physical examination, and in most patients, chest radiography. […] The most common causes of chronic cough in adults are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, alone or in combination. […] The diagnosis of asthma should be confirmed based on clinical response to empiric therapy with inhaled bronchodilators or corticosteroids. […] Empiric treatment for gastroesophageal reflux disease should be initiated in lieu of testing for patients with chronic cough and reflux symptoms. […] Further testing, such as high-resolution computed tomography, and referral to a pulmonologist may be indicated if the cause of chronic cough is not identified.

• #52 Chronic Cough: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1101/p575.html

  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. […] 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. […] The diagnostic approach should focus on detection and treatment of the four most common causes of chronic cough in adults: upper airway cough syndrome (UACS), asthma, nonasthmatic eosinophilic bronchitis, and gastroesophageal reflux disease (GERD)/laryngopharyngeal reflux disease.

• #53 Chronic Cough: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1101/p575.html

  In patients with refractory chronic cough, referral to a pulmonologist or otolaryngologist should be considered, as well as a trial of gabapentin (Neurontin), pregabalin (Lyrica), or speech therapy. […] The most common causes of chronic cough in children six to 14 years of age are asthma, protracted bacterial bronchitis, and UACS. […] Chronic cough in children younger than 15 years is defined as cough lasting more than four weeks. […] The prevalence of asthma in patients with chronic cough ranges from 24% to 29%. […] Nonasthmatic eosinophilic bronchitis is characterized by chronic cough in patients with no symptoms or objective evidence of variable airflow obstruction, normal airway responsiveness on a methacholine inhalation test, and sputum eosinophilia. […] The prevalence of GERD and laryngopharyngeal reflux disease as causative factors in chronic cough varies from 0% to 73%. […] ACE inhibitorrelated cough has been reported in 5% to 35% of patients and is more common in women. […] Patients with unexplained chronic cough after evaluation and treatment of common causes should be referred to a pulmonologist or otolaryngologist.

• #54 The spectrum, clinical features and diagnosis of chronic cough due to rare causes – Lai – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/51121/html

  Chronic cough has many diverse causes, including common and uncommon causes. […] The purpose of this study is to determine the etiological distribution, clinical features, and diagnostic value of special examinations in patients with rare causes of chronic cough. […] Causes of chronic cough with a prevalence of less than 3% were defined as rare causes. […] Among the 31 rare causes of chronic cough in this cohort, the top five were protracted bacterial bronchitis, somatic cough syndrome, diffuse panbronchiolitis, OSAS, and interstitial lung disease. […] Special examinations, such as chest HRCT and bronchoscopy, should be considered after excluding common causes of chronic cough. […] The diagnosis of rare causes depends on special examinations, such as high-resolution computed tomography (HRCT), nasopharyngoscopy, or bronchoscopy.

• #55 The spectrum, clinical features and diagnosis of chronic cough due to rare causes – Lai – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/51121/html

  This study showed that many rare causes of chronic cough were misdiagnosed as chronic bronchitis or chronic pharyngitis. […] Therefore, we propose that HRCT and bronchoscopy should be considered if no abnormalities are observed in routine examinations and if patients do not respond to empirical treatment. […] Diagnosing rare causes of chronic cough is a challenge for clinicians. […] Special examinations such as HRCT and bronchoscopy play an important role in diagnosing rare causes and should be considered based on the patients condition after excluding common causes of chronic cough.

• #56 Evaluation of chronic cough – Diagnosis Approach | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/69/diagnosis-approach

  If none of the four most common causes seem likely after thorough assessment, other tests to consider include: High-resolution CT imaging of the chest to look for bronchiectasis, foreign body aspiration, pulmonary fibrosis, or other structural lung disease. […] If UACS is suspected, a therapeutic trial aimed at resolving rhinosinusitis and reducing excessive secretions is indicated. […] A therapeutic trial of proton pump inhibitors (PPIs) is recommended for patients with typical GERD symptoms (heartburn and regurgitation). […] Diagnostic testing (including esophageal pH monitoring and endoscopy) may be considered according to clinician or patient preference in those refractory to a therapeutic trial of PPIs, or where there is a strong clinical suspicion of reflux-related cough. […] Therapeutic trials are selected based on clinical impression, at times supported by diagnostic testing.

• #57 The spectrum, clinical features and diagnosis of chronic cough due to rare causes – Lai – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/51121/html

  This study showed that many rare causes of chronic cough were misdiagnosed as chronic bronchitis or chronic pharyngitis. […] Therefore, we propose that HRCT and bronchoscopy should be considered if no abnormalities are observed in routine examinations and if patients do not respond to empirical treatment. […] Diagnosing rare causes of chronic cough is a challenge for clinicians. […] Special examinations such as HRCT and bronchoscopy play an important role in diagnosing rare causes and should be considered based on the patients condition after excluding common causes of chronic cough.

• #58 Chronic Cough | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/chronic-cough/

  Patients might need one or more additional tests, such as: Acid reflux/pH/impedance test: Measures the amount of acidic and non-acidic fluid inside the esophagus, Allergy testing: Skin or blood test to assess for systemic allergies, Bronchoscopy: Test that uses a narrow, lighted scope inserted through the mouth into the windpipe to look inside the lungs, Chest X-ray: Imaging technology that uses radiation to produce images of the lungs to check for cancer, pneumonia, or other lung diseases, Computed tomography (CT) scan: Specialized X-ray technology that takes cross-sectional images to produce 3D images of the chest to look for disease, Lab tests: Tests of phlegm to check for infection, Laryngoscopy: A test that uses a narrow, lighted scope for visualization of the throat and upper airway, Lung function tests: Noninvasive tests that can diagnose asthma and COPD by measuring lung capacity and exhalation speed, Rhinoscopy: Test that uses a lighted scope to look inside the nasal passages.

• #59 Chronic Cough | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/chronic-cough/

  Patients might need one or more additional tests, such as: Acid reflux/pH/impedance test: Measures the amount of acidic and non-acidic fluid inside the esophagus, Allergy testing: Skin or blood test to assess for systemic allergies, Bronchoscopy: Test that uses a narrow, lighted scope inserted through the mouth into the windpipe to look inside the lungs, Chest X-ray: Imaging technology that uses radiation to produce images of the lungs to check for cancer, pneumonia, or other lung diseases, Computed tomography (CT) scan: Specialized X-ray technology that takes cross-sectional images to produce 3D images of the chest to look for disease, Lab tests: Tests of phlegm to check for infection, Laryngoscopy: A test that uses a narrow, lighted scope for visualization of the throat and upper airway, Lung function tests: Noninvasive tests that can diagnose asthma and COPD by measuring lung capacity and exhalation speed, Rhinoscopy: Test that uses a lighted scope to look inside the nasal passages.

• #60 Chronic Cough | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/chronic-cough/

  Patients might need one or more additional tests, such as: Acid reflux/pH/impedance test: Measures the amount of acidic and non-acidic fluid inside the esophagus, Allergy testing: Skin or blood test to assess for systemic allergies, Bronchoscopy: Test that uses a narrow, lighted scope inserted through the mouth into the windpipe to look inside the lungs, Chest X-ray: Imaging technology that uses radiation to produce images of the lungs to check for cancer, pneumonia, or other lung diseases, Computed tomography (CT) scan: Specialized X-ray technology that takes cross-sectional images to produce 3D images of the chest to look for disease, Lab tests: Tests of phlegm to check for infection, Laryngoscopy: A test that uses a narrow, lighted scope for visualization of the throat and upper airway, Lung function tests: Noninvasive tests that can diagnose asthma and COPD by measuring lung capacity and exhalation speed, Rhinoscopy: Test that uses a lighted scope to look inside the nasal passages.

• #61 Evaluation of chronic cough – Diagnosis Approach | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/69/diagnosis-approach

  If none of the four most common causes seem likely after thorough assessment, other tests to consider include: High-resolution CT imaging of the chest to look for bronchiectasis, foreign body aspiration, pulmonary fibrosis, or other structural lung disease. […] If UACS is suspected, a therapeutic trial aimed at resolving rhinosinusitis and reducing excessive secretions is indicated. […] A therapeutic trial of proton pump inhibitors (PPIs) is recommended for patients with typical GERD symptoms (heartburn and regurgitation). […] Diagnostic testing (including esophageal pH monitoring and endoscopy) may be considered according to clinician or patient preference in those refractory to a therapeutic trial of PPIs, or where there is a strong clinical suspicion of reflux-related cough. […] Therapeutic trials are selected based on clinical impression, at times supported by diagnostic testing.

• #62 Chronic Cough | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/chronic-cough/

  Patients might need one or more additional tests, such as: Acid reflux/pH/impedance test: Measures the amount of acidic and non-acidic fluid inside the esophagus, Allergy testing: Skin or blood test to assess for systemic allergies, Bronchoscopy: Test that uses a narrow, lighted scope inserted through the mouth into the windpipe to look inside the lungs, Chest X-ray: Imaging technology that uses radiation to produce images of the lungs to check for cancer, pneumonia, or other lung diseases, Computed tomography (CT) scan: Specialized X-ray technology that takes cross-sectional images to produce 3D images of the chest to look for disease, Lab tests: Tests of phlegm to check for infection, Laryngoscopy: A test that uses a narrow, lighted scope for visualization of the throat and upper airway, Lung function tests: Noninvasive tests that can diagnose asthma and COPD by measuring lung capacity and exhalation speed, Rhinoscopy: Test that uses a lighted scope to look inside the nasal passages.

• #63 What is Chronic Cough Syndrome?

  https://www.aaaai.org/tools-for-the-public/conditions-library/asthma/what-is-chronic-cough-syndrome

  chronic cough syndrome Symptoms Diagnosis Cough is a very common symptom, with multiple causes, that most people have experienced at some time in their life. Chronic cough syndrome refers to a cough that persists for a longer period of time, usually defined as 6 weeks or longer. Consulting with your allergist / immunologist is an important first step in figuring out the cause or causes of your chronic cough. The physical examination can also be helpful. These initial steps will help determine which tests, if any are needed, to find the cause(s) of the cough. There are many methods used to diagnose the cause of chronic cough syndrome. Allergy testing can determine if you are allergic to any inhalant allergens (such as tree, grass or weed pollens, mold, pets or dust mites), as allergic rhinitis and associated post-nasal drip is an important cause of chronic cough. Lung tests, or breathing tests, can help your allergist / immunologist diagnose the cause of the cough. Radiological tests include a CT (CAT) scan of your sinuses and a chest x-ray. Gastroesophageal reflux disease (GERD) can present with heartburn, or indigestion symptoms, and is also known as reflux. It is important to note that you may not even feel or sense the heartburn, you may simply have the cough. While there are certain procedures available to diagnose GERD, often your allergist / immunologist may place you on a GERD medication for a certain period of time and assess if your cough symptoms improve. Finally, if diagnostic testing and management of these common conditions are not helpful, many patients can benefit from therapies to help decrease throat sensitivity, known as cough hypersensitivity syndrome (e.g. habit cough), that can contribute to cough. A variety of treatment options exist for chronic cough syndrome, depending on the cause(s) or suspected cause(s). Therefore, management often relies in a multidisciplinary approach with the help of allergists, pulmonologists, speech therapists, otorhinolaryngologists and gastroenterologists working together to address your symptoms.

• #64 Assessment and Management of Chronic Cough | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/chronic-cough/research-protocol

  The diagnosis and management of cough has been the subject of several guideline efforts, two aimed at assessment of cough in adults and one focused on children. […] According to these guidelines, initial clinical evaluation is aimed at determining the cause or underlying etiology of cough based on history, physical examination, and, if the cough is chronic, chest x-ray. […] Several measurement methods exist to evaluate cough severity, including health-related quality of life (HRQOL) instruments, visual analog scales, cough counts (using real-time wearable computerized equipment), and tussigenic challenge. […] If treatment of the underlying etiology fails to resolve the cough, or if no cause can be identified, then the cough may be treated symptomatically. […] In most cases, symptomatic treatment consists of antitussive therapy to decrease the frequency and severity of the cough.

• #65 Idiopathic chronic cough: a real disease or a failure of diagnosis? | Cough | Full Text

  https://coughjournal.biomedcentral.com/articles/10.1186/1745-9974-1-9

  Despite extensive diagnostic evaluation and numerous treatment trials, a number of patients remain troubled by a chronic and uncontrollable cough. […] Eosinophilic bronchitis, atopic cough and non-acid reflux have been recently added to the diagnostic spectrum for chronic cough. […] In some cases, failure to consider these conditions may explain treatment failure. […] However, a subset of patients with persisting symptoms may be regarded as having an idiopathic cough. […] This article seeks to examine the evidence for idiopathic cough as either a distinct diagnosis or simply the result of incomplete evaluation and inadequate courses of therapy. […] Although the systematic evaluation of both extrapulmonary and pulmonary causes for cough is widely held to be effective, doubt has been cast on the perception that the diagnostic triad of CVA, PNDS and GORD accounts for the almost all causes of chronic cough.

• #66 Idiopathic chronic cough: a real disease or a failure of diagnosis? | Cough | Full Text

  https://coughjournal.biomedcentral.com/articles/10.1186/1745-9974-1-9

  Despite extensive diagnostic evaluation and numerous treatment trials, a number of patients remain troubled by a chronic and uncontrollable cough. […] Eosinophilic bronchitis, atopic cough and non-acid reflux have been recently added to the diagnostic spectrum for chronic cough. […] In some cases, failure to consider these conditions may explain treatment failure. […] However, a subset of patients with persisting symptoms may be regarded as having an idiopathic cough. […] This article seeks to examine the evidence for idiopathic cough as either a distinct diagnosis or simply the result of incomplete evaluation and inadequate courses of therapy. […] Although the systematic evaluation of both extrapulmonary and pulmonary causes for cough is widely held to be effective, doubt has been cast on the perception that the diagnostic triad of CVA, PNDS and GORD accounts for the almost all causes of chronic cough.

• #67 Evaluation of the Patient with Chronic Cough | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p887.html

  In children, a cough lasting longer than four weeks is considered chronic. […] The most common causes in children are respiratory tract infections, asthma, and gastroesophageal reflux disease. […] Evaluation of children with chronic cough should include chest radiography and spirometry. […] Chronic cough can be associated with significant distress and impairment in quality of life. […] This article presents a systematic approach to the evaluation of chronic cough based on the results of prospective studies and an evidence-based practice guideline. […] Most episodes of chronic cough in adults are caused by upper airway cough syndrome (UACS, also known as postnasal drip syndrome), asthma, or gastroesophageal reflux disease (GERD), alone or in combination. […] Chronic cough has two or more causes in 18 to 62 percent of patients, and three causes in up to 42 percent of patients.

• #68 Evaluation of chronic cough – Diagnosis Approach | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/69/diagnosis-approach

  The patient’s response to the trial must be assessed and the cough resolved before a given etiology may be assigned with certainty. […] A partial response may indicate that more than one etiology is in play. […] In this event, further testing and/or additional therapeutic trials may be indicated, while the partially successful therapy should be continued. […] Lack of a response requires reassessment both of suspected etiology and of treatment adherence and effectiveness.

• #69 The spectrum, clinical features and diagnosis of chronic cough due to rare causes – Lai – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/51121/html

  Chronic cough has many diverse causes, including common and uncommon causes. […] The purpose of this study is to determine the etiological distribution, clinical features, and diagnostic value of special examinations in patients with rare causes of chronic cough. […] Causes of chronic cough with a prevalence of less than 3% were defined as rare causes. […] Among the 31 rare causes of chronic cough in this cohort, the top five were protracted bacterial bronchitis, somatic cough syndrome, diffuse panbronchiolitis, OSAS, and interstitial lung disease. […] Special examinations, such as chest HRCT and bronchoscopy, should be considered after excluding common causes of chronic cough. […] The diagnosis of rare causes depends on special examinations, such as high-resolution computed tomography (HRCT), nasopharyngoscopy, or bronchoscopy.

• #70

  https://journals.lww.com/lungindia/fulltext/2015/32010/chronic_dry_cough__diagnostic_and_management.11.aspx

  The term cough hypersensitivity syndrome views chronic cough from a more mechanistic standpoint. In this view, chronic cough is considered as a single syndrome with a common intrinsic mechanism of cough hypersensitivity. […] Antitussive therapies should be considered in patients with chronic dry cough when the cause of the increased cough reflex is unexplained and treatment against the potential aggravating factors is not satisfactory.

• #71 Overview of Chronic Cough

  https://www.ajmc.com/view/overview-of-chronic-cough

  The global prevalence of CC in adults was reported to be almost 10% (95% CI, 7.6%-11.7%) in a meta-analysis. […] A cough may be caused by excessive stimulation of a normal cough response; however, most people presenting with CC have cough reflex hypersensitivity and complaints of sensitivity to environmental irritants that leads to a tickling sensation in the throat and the urge to cough. […] CC affects nearly every organ system, and complications such as hemoptysis should be immediately addressed and evaluated. […] CC causes a decreased QOL and a sizeable socioeconomic burden. […] New and effective therapies are required in order to decrease the burden of this disease, but due to the heterogeneity of CC, a one-size-fits-all treatment is not possible. […] A better understanding of the phenotypes of chronic cough is necessary in tandem with a better understanding of potential treatment targets.

• #72 Idiopathic chronic cough: a real disease or a failure of diagnosis? | Cough | Full Text

  https://coughjournal.biomedcentral.com/articles/10.1186/1745-9974-1-9

  For some, this represents a population with idiopathic cough but others suggest it reflects failed management. […] The common and less common associations with cough must be rigorously excluded before a diagnosis of idiopathic cough can be assigned. […] None-the-less, this author firmly believes such a condition exists and it will be addressed in some detail in the following section. […] Although inadequate management will continue to explain a significant number of patients with a chronic and uncontrollable cough, an attempt has been made in this article to highlight idiopathic cough as a distinct clinical entity. […] The excess of middle-aged females with idiopathic cough raises the possibility of some sex hormonal influence.

• #73 Chronic Cough – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430791/

  Chronic cough has a global prevalence of 3% to 18% in the general adult population and is affected by several factors, such as smoking and age. […] The initial assessment of a chronic cough typically involves a chest radiograph and pulmonary function tests (PFTs). […] If UACS is suspected, a trial of nasal saline rinses, a first-generation antihistamine, and nasal steroids is recommended. […] The management of chronic cough caused by asthma is similar to the initial treatment of asthma using a stepwise approach. […] In idiopathic chronic cough, several treatments may be considered, including opiates and nonopioid pharmacological treatments. […] The differential diagnosis of chronic cough includes the following conditions: Bronchiolitis, Bronchogenic carcinoma, Chronic aspiration, Congestive heart failure, Foreign body aspiration, Neuromuscular disorders, Psychogenic cough.

• #74 Idiopathic chronic cough: a real disease or a failure of diagnosis? | Cough | Full Text

  https://coughjournal.biomedcentral.com/articles/10.1186/1745-9974-1-9

  For some, this represents a population with idiopathic cough but others suggest it reflects failed management. […] The common and less common associations with cough must be rigorously excluded before a diagnosis of idiopathic cough can be assigned. […] None-the-less, this author firmly believes such a condition exists and it will be addressed in some detail in the following section. […] Although inadequate management will continue to explain a significant number of patients with a chronic and uncontrollable cough, an attempt has been made in this article to highlight idiopathic cough as a distinct clinical entity. […] The excess of middle-aged females with idiopathic cough raises the possibility of some sex hormonal influence.

• #75 Diagnosis and management of chronic cough: similarities and differences between children and adults

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7385707/

  An additional specific cause of chronic cough reported for adults is enlarged tonsils. […] The recommended etiologies to be treated in reviews are gastroesophageal reflux and upper airway cough syndrome. […] Pharmacologic treatments that modulate neuronal function have been considered for chronic intractable cough in adults when there is no medical diagnosis. […] The observation that adults can stop coughing when watching a video of suggestion therapy given to a child suggests a habit cough diagnosis for those adults. […] The most apparent difference is the diagnosis of children with chronic cough by a systematic approach leaves few without a medical explanation. […] Without a specific diagnosis other than cough hypersensitivity, treatment of adult chronic cough has focused on pharmacological medication. […] Thus, there is limited value of pharmacotherapy for chronic cough in adults and the similarities to habit cough in children suggest further exploration and use of non-medication behavioral responses for chronic unexplained cough in adults.

• #76 Chronic Cough; Management and Diagnosis – Los Angeles Allergist

  https://allergylosangeles.com/allergy-blog/chronic-cough-management-and-diagnosis/

  Chronic cough includes an assessment and management of the underlying cause. In many as 40% of the patients, the cough remains unexplained and persistent. A number of treatment options are available to patients such as gabapentin, pregablin, amitriptyline and morphine. There are also a number of clinical trials available in the management of refractory chronic cough. Overall, clinical management is directed at identifying and treating cough stimuli (exposures, diseases) and managing the components of cough hypersensitivity. This approach leads to a reduction in cough and improved quality of life for those who have chronic cough.

• #77 Chronic Cough: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1101/p575.html

  In patients with refractory chronic cough, referral to a pulmonologist or otolaryngologist should be considered, as well as a trial of gabapentin (Neurontin), pregabalin (Lyrica), or speech therapy. […] The most common causes of chronic cough in children six to 14 years of age are asthma, protracted bacterial bronchitis, and UACS. […] Chronic cough in children younger than 15 years is defined as cough lasting more than four weeks. […] The prevalence of asthma in patients with chronic cough ranges from 24% to 29%. […] Nonasthmatic eosinophilic bronchitis is characterized by chronic cough in patients with no symptoms or objective evidence of variable airflow obstruction, normal airway responsiveness on a methacholine inhalation test, and sputum eosinophilia. […] The prevalence of GERD and laryngopharyngeal reflux disease as causative factors in chronic cough varies from 0% to 73%. […] ACE inhibitorrelated cough has been reported in 5% to 35% of patients and is more common in women. […] Patients with unexplained chronic cough after evaluation and treatment of common causes should be referred to a pulmonologist or otolaryngologist.

• #78 Chronic Cough – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430791/

  Chronic cough has a global prevalence of 3% to 18% in the general adult population and is affected by several factors, such as smoking and age. […] The initial assessment of a chronic cough typically involves a chest radiograph and pulmonary function tests (PFTs). […] If UACS is suspected, a trial of nasal saline rinses, a first-generation antihistamine, and nasal steroids is recommended. […] The management of chronic cough caused by asthma is similar to the initial treatment of asthma using a stepwise approach. […] In idiopathic chronic cough, several treatments may be considered, including opiates and nonopioid pharmacological treatments. […] The differential diagnosis of chronic cough includes the following conditions: Bronchiolitis, Bronchogenic carcinoma, Chronic aspiration, Congestive heart failure, Foreign body aspiration, Neuromuscular disorders, Psychogenic cough.

• #79 Chronic Cough; Management and Diagnosis – Los Angeles Allergist

  https://allergylosangeles.com/allergy-blog/chronic-cough-management-and-diagnosis/

  Chronic cough includes an assessment and management of the underlying cause. In many as 40% of the patients, the cough remains unexplained and persistent. A number of treatment options are available to patients such as gabapentin, pregablin, amitriptyline and morphine. There are also a number of clinical trials available in the management of refractory chronic cough. Overall, clinical management is directed at identifying and treating cough stimuli (exposures, diseases) and managing the components of cough hypersensitivity. This approach leads to a reduction in cough and improved quality of life for those who have chronic cough.

• #80 Unexplained chronic cough | informedhealth.org

  https://www.informedhealth.org/unexplained-chronic-cough.html

  A chronic cough is a cough that lasts for longer than eight weeks. If healthcare professionals are unable to identify the cause of the cough, its referred to as unexplained. […] If the doctor cant identify a cause, even after extensive tests and examinations, theyll diagnose you with unexplained chronic cough. This condition is also sometimes called idiopathic cough or refractory cough. […] Your family doctor can usually do the first round of tests necessary for chronic coughs. Any additional examinations need to be done by a lung specialist (a pulmonologist) or an ENT (ears, nose and throat) specialist. […] If its still not clear whats causing your chronic cough after all these examinations, it will be diagnosed as unexplained chronic cough. Experts recommend that people who have this condition should go for regular specialist check-ups.

• #81 Chronic Cough – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430791/

  Cough is a distinct and independent factor that can serve as an indicator of disease progression. […] Chronic cough, when left unaddressed, can lead to a range of complications that significantly impact an individual’s quality of life. […] Deterrence and prevention strategies for chronic cough aim to mitigate the underlying causes and reduce the risk of persistent respiratory symptoms. […] Chronic cough necessitates an interprofessional team due to its multitude of potential causes.

• #82 Chronic cough diagnosis, treatment, and referral practices among family physicians in the United States: a survey study | BMC Primary Care | Full Text

  https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-024-02433-1

  Cough is one of the most common presenting problems for patients in primary care and is largely managed in primary care clinical settings. […] The objective of this study was to characterize current diagnosis, treatment, and referral practices among family physicians and to identify potentially impactful strategies to optimize chronic cough management in primary care. […] About half (49.6%) of respondents defined chronic cough in a manner consistent with the American College of Chest Physicians (ACCP) chronic cough guidelines, with the rest differing in opinion primarily regarding duration of symptom presentation. […] Respondents reported trying to rule out most common causes of chronic cough themselves before referring and indicated a desire for more resources to help them manage and treat chronic cough.

• #83 Chronic cough diagnosis, treatment, and referral practices among family physicians in the United States: a survey study | BMC Primary Care | Full Text

  https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-024-02433-1

  Family physicians see chronic cough as a complicated condition that can be and is often diagnosed and treated entirely in a primary care setting. […] Our results support that family physicians provide evidence-based management of chronic cough. […] The American College of Chest Physicians (ACCP) recommends a diagnosis algorithm based on patient history and examination and categorizes cough by duration: 3 weeks is considered acute; 38 weeks is subacute; and 8 weeks is considered chronic. […] The ACCP guidelines have been adopted by several different specialties and have been endorsed by the American Academy of Family Physicians (AAFP) for use in family medicine and primary care. […] Respondents rated the following items useful for evaluation and diagnosis: smoking status, medication history, exposure to environmental irritants, spirometry if asthma is suspected, and pulmonary function studies. […] Respondents indicated slight disagreement with statements stating they have a good understanding of the causes of chronic cough and that they are confident in their abilities to evaluate and treat chronic cough.

• #84 Chronic cough diagnosis, treatment, and referral practices among family physicians in the United States: a survey study | BMC Primary Care | Full Text

  https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-024-02433-1

  Family physicians indicated at least sometimes referring chronic cough patients to specialists. […] Most respondents indicated conducting their evaluation in phases and assessing for and ruling out most common causes of chronic cough before referral to a specialist. […] Family physicians use multiple factors to determine when a cough is chronic, but when prompted, generally agree with the ACCP guidelines of longer than 8 weeks. […] Family physicians prefer to treat chronic cough themselves and report a patient-centered approach to caring for patients with chronic cough, including referral to specialists when appropriate.

• #85 Diagnosing Chronic Cough | NYU Langone Health

  https://nyulangone.org/conditions/chronic-cough-in-children/diagnosis

  Through physical exams and other tests, our pulmonologists can diagnose the cause of your child’s chronic cough. […] Our specialists can diagnose the precise cause of your child’s chronic cough. Our pulmonologists, or lung specialists, begin with a comprehensive physical exam to assess your child’s symptoms, followed by additional tests to check for bacterial infection and to rule out other possible causes. […] If needed, our pulmonologists make referrals to other specialists, such as gastroenterologists or infectious disease specialists, who can confirm and treat less common causes of chronic cough in children. […] Lung function tests play a major role in identifying the cause of a chronic cough and can be performed in children as young as age 5. Depending on the possible cause of the cough, our doctors may perform one or more of the following tests: […] This test may be used when the cause of a chronic cough cannot be determined with a physical exam and sputum culture, or if the cough remains after treatment. […] After our doctors establish the correct diagnosis, the next step is to select the appropriate treatment for your child.

• #86 Diagnosis and management of chronic cough: similarities and differences between children and adults

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7385707/

  An additional specific cause of chronic cough reported for adults is enlarged tonsils. […] The recommended etiologies to be treated in reviews are gastroesophageal reflux and upper airway cough syndrome. […] Pharmacologic treatments that modulate neuronal function have been considered for chronic intractable cough in adults when there is no medical diagnosis. […] The observation that adults can stop coughing when watching a video of suggestion therapy given to a child suggests a habit cough diagnosis for those adults. […] The most apparent difference is the diagnosis of children with chronic cough by a systematic approach leaves few without a medical explanation. […] Without a specific diagnosis other than cough hypersensitivity, treatment of adult chronic cough has focused on pharmacological medication. […] Thus, there is limited value of pharmacotherapy for chronic cough in adults and the similarities to habit cough in children suggest further exploration and use of non-medication behavioral responses for chronic unexplained cough in adults.

• #87 Diagnosing Chronic Cough | NYU Langone Health

  https://nyulangone.org/conditions/chronic-cough-in-children/diagnosis

  Through physical exams and other tests, our pulmonologists can diagnose the cause of your child’s chronic cough. […] Our specialists can diagnose the precise cause of your child’s chronic cough. Our pulmonologists, or lung specialists, begin with a comprehensive physical exam to assess your child’s symptoms, followed by additional tests to check for bacterial infection and to rule out other possible causes. […] If needed, our pulmonologists make referrals to other specialists, such as gastroenterologists or infectious disease specialists, who can confirm and treat less common causes of chronic cough in children. […] Lung function tests play a major role in identifying the cause of a chronic cough and can be performed in children as young as age 5. Depending on the possible cause of the cough, our doctors may perform one or more of the following tests: […] This test may be used when the cause of a chronic cough cannot be determined with a physical exam and sputum culture, or if the cough remains after treatment. […] After our doctors establish the correct diagnosis, the next step is to select the appropriate treatment for your child.

• #88 Chronic Cough | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/chronic-cough/

  UT Southwestern Medical Center provides expert care for people who have a chronic cough and other conditions affecting the airways, larynx (voice box), throat, and lungs. Using the latest technology, we work to evaluate, diagnose, and treat the underlying causes of chronic cough. […] Our physicians, therapists, and researchers are widely recognized as experts in the accurate diagnosis and effective treatment of chronic cough. […] At UT Southwestern, our experienced doctors conduct a thorough evaluation, which includes a: Physical exam, Review of medical history, Discussion of symptoms. […] Depending on each patients specific needs, we sometimes work with specialists from other areas of medicine, such as gastroenterology. Based on our evaluation, we often begin treatment for one of the common causes of coughing. If initial treatment doesnt help, we then order additional tests for a less common cause.

• #89 What is Chronic Cough Syndrome?

  https://www.aaaai.org/tools-for-the-public/conditions-library/asthma/what-is-chronic-cough-syndrome

  chronic cough syndrome Symptoms Diagnosis Cough is a very common symptom, with multiple causes, that most people have experienced at some time in their life. Chronic cough syndrome refers to a cough that persists for a longer period of time, usually defined as 6 weeks or longer. Consulting with your allergist / immunologist is an important first step in figuring out the cause or causes of your chronic cough. The physical examination can also be helpful. These initial steps will help determine which tests, if any are needed, to find the cause(s) of the cough. There are many methods used to diagnose the cause of chronic cough syndrome. Allergy testing can determine if you are allergic to any inhalant allergens (such as tree, grass or weed pollens, mold, pets or dust mites), as allergic rhinitis and associated post-nasal drip is an important cause of chronic cough. Lung tests, or breathing tests, can help your allergist / immunologist diagnose the cause of the cough. Radiological tests include a CT (CAT) scan of your sinuses and a chest x-ray. Gastroesophageal reflux disease (GERD) can present with heartburn, or indigestion symptoms, and is also known as reflux. It is important to note that you may not even feel or sense the heartburn, you may simply have the cough. While there are certain procedures available to diagnose GERD, often your allergist / immunologist may place you on a GERD medication for a certain period of time and assess if your cough symptoms improve. Finally, if diagnostic testing and management of these common conditions are not helpful, many patients can benefit from therapies to help decrease throat sensitivity, known as cough hypersensitivity syndrome (e.g. habit cough), that can contribute to cough. A variety of treatment options exist for chronic cough syndrome, depending on the cause(s) or suspected cause(s). Therefore, management often relies in a multidisciplinary approach with the help of allergists, pulmonologists, speech therapists, otorhinolaryngologists and gastroenterologists working together to address your symptoms.

• #90 What is Chronic Cough Syndrome?

  https://www.aaaai.org/tools-for-the-public/conditions-library/asthma/what-is-chronic-cough-syndrome

  chronic cough syndrome Symptoms Diagnosis Cough is a very common symptom, with multiple causes, that most people have experienced at some time in their life. Chronic cough syndrome refers to a cough that persists for a longer period of time, usually defined as 6 weeks or longer. Consulting with your allergist / immunologist is an important first step in figuring out the cause or causes of your chronic cough. The physical examination can also be helpful. These initial steps will help determine which tests, if any are needed, to find the cause(s) of the cough. There are many methods used to diagnose the cause of chronic cough syndrome. Allergy testing can determine if you are allergic to any inhalant allergens (such as tree, grass or weed pollens, mold, pets or dust mites), as allergic rhinitis and associated post-nasal drip is an important cause of chronic cough. Lung tests, or breathing tests, can help your allergist / immunologist diagnose the cause of the cough. Radiological tests include a CT (CAT) scan of your sinuses and a chest x-ray. Gastroesophageal reflux disease (GERD) can present with heartburn, or indigestion symptoms, and is also known as reflux. It is important to note that you may not even feel or sense the heartburn, you may simply have the cough. While there are certain procedures available to diagnose GERD, often your allergist / immunologist may place you on a GERD medication for a certain period of time and assess if your cough symptoms improve. Finally, if diagnostic testing and management of these common conditions are not helpful, many patients can benefit from therapies to help decrease throat sensitivity, known as cough hypersensitivity syndrome (e.g. habit cough), that can contribute to cough. A variety of treatment options exist for chronic cough syndrome, depending on the cause(s) or suspected cause(s). Therefore, management often relies in a multidisciplinary approach with the help of allergists, pulmonologists, speech therapists, otorhinolaryngologists and gastroenterologists working together to address your symptoms.

• #91 What is Chronic Cough Syndrome?

  https://www.aaaai.org/tools-for-the-public/conditions-library/asthma/what-is-chronic-cough-syndrome

  chronic cough syndrome Symptoms Diagnosis Cough is a very common symptom, with multiple causes, that most people have experienced at some time in their life. Chronic cough syndrome refers to a cough that persists for a longer period of time, usually defined as 6 weeks or longer. Consulting with your allergist / immunologist is an important first step in figuring out the cause or causes of your chronic cough. The physical examination can also be helpful. These initial steps will help determine which tests, if any are needed, to find the cause(s) of the cough. There are many methods used to diagnose the cause of chronic cough syndrome. Allergy testing can determine if you are allergic to any inhalant allergens (such as tree, grass or weed pollens, mold, pets or dust mites), as allergic rhinitis and associated post-nasal drip is an important cause of chronic cough. Lung tests, or breathing tests, can help your allergist / immunologist diagnose the cause of the cough. Radiological tests include a CT (CAT) scan of your sinuses and a chest x-ray. Gastroesophageal reflux disease (GERD) can present with heartburn, or indigestion symptoms, and is also known as reflux. It is important to note that you may not even feel or sense the heartburn, you may simply have the cough. While there are certain procedures available to diagnose GERD, often your allergist / immunologist may place you on a GERD medication for a certain period of time and assess if your cough symptoms improve. Finally, if diagnostic testing and management of these common conditions are not helpful, many patients can benefit from therapies to help decrease throat sensitivity, known as cough hypersensitivity syndrome (e.g. habit cough), that can contribute to cough. A variety of treatment options exist for chronic cough syndrome, depending on the cause(s) or suspected cause(s). Therefore, management often relies in a multidisciplinary approach with the help of allergists, pulmonologists, speech therapists, otorhinolaryngologists and gastroenterologists working together to address your symptoms.

• #92 Chronic cough diagnosis and treatment | Top Doctors

  https://www.topdoctors.co.uk/medical-articles/when-coughing-won-t-stop-chronic-cough-diagnosis-and-treatment

  When all known causes of chronic cough have been excluded and the cough is still persistent, the skills of a highly specialised chronic cough centre might be required. […] The treatment of chronic cough can be a long process with many diagnostic tests involved to discover the source of the cough. Based on your specific case, your specialist will advise you on which treatments could be the most effective for you.

• #93

• #94 Evaluation of chronic cough – Diagnosis Approach | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/69/diagnosis-approach

  Although no specific history or physical exam findings are reliably associated with specific etiology of chronic cough, they may direct further testing or therapeutic trials. […] The symptoms and findings associated with the common causes (asthma, UACS, GERD, or NAEB) may direct further diagnostic evaluation toward confirming that cause. […] A chest x-ray should be obtained early in the evaluation of chronic cough. […] Although it is not diagnostic of the most common causes, findings may quickly divert the evaluation to causes of greater gravity, such as structural lung diseases. […] Following chest x-ray, the choice of either diagnostic testing or therapeutic trials depends on the clinician’s assessed probability of a specific etiology and the patient’s preferred approach. […] Unless the history, physical examination, and chest x-ray indicate otherwise, efforts should be concentrated on one or more of the four most common causes (asthma, UACS, GERD, NAEB).

• #95 Chronic Cough in Adults (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/chronic-persistent-cough-in-adults-pro

  The most common causes of chronic cough, other than smoking in adults, are postnasal drip, asthma and gastro-oesophageal reflux disease (GORD). […] Studies have shown a low frequency of serious pulmonary conditions in patients who have an isolated chronic dry cough and normal physical examination, CXR and spirogram. […] A suggested strategy for primary care, using the principle of diagnosis by 'test of treatment’ is: History and examination. Look for 'red flags’ which require early investigation. […] If initial management is unsuccessful, referral to secondary care may be required. This may involve a chest physician, ENT specialist and/or gastroenterologist, depending on the individual context. […] There are various drugs which may partially suppress cough and chronic cough, although the cough reflex is exceedingly difficult to abolish. […] When there is no identifiable cause, cough suppressants may be useful, particularly if sleep is disturbed. […] Chronic cough may be a presentation of a complex involuntary tic (eg, as sometimes seen in Tourettes syndrome).

• #96 Chronic cough – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-cough/diagnosis-treatment/drc-20351580

  Your healthcare professional asks about your medical history and does a physical exam. A thorough medical history and physical exam can give important clues about a chronic cough. Your health professional also may order tests to look for the cause of your chronic cough. […] But many health professionals start treatment for one of the common causes of chronic cough rather than ordering expensive tests. If the treatment doesn’t work, you may be tested for less common causes. […] A chest X-ray and spirometry, at a minimum, are usually ordered to find the cause of a chronic cough in children. […] Finding out what’s causing a chronic cough is very important to effective treatment. In many cases, more than one underlying condition may be causing your chronic cough. […] Your healthcare professional works to find the cause of your cough and the best treatment for you. During that time, your healthcare professional also may prescribe a medicine to reduce coughing, called a cough suppressant. Cough suppressants are not recommended for children.

• #97 Unexplained chronic cough | informedhealth.org

  https://www.informedhealth.org/unexplained-chronic-cough.html

  A chronic cough is a cough that lasts for longer than eight weeks. If healthcare professionals are unable to identify the cause of the cough, its referred to as unexplained. […] If the doctor cant identify a cause, even after extensive tests and examinations, theyll diagnose you with unexplained chronic cough. This condition is also sometimes called idiopathic cough or refractory cough. […] Your family doctor can usually do the first round of tests necessary for chronic coughs. Any additional examinations need to be done by a lung specialist (a pulmonologist) or an ENT (ears, nose and throat) specialist. […] If its still not clear whats causing your chronic cough after all these examinations, it will be diagnosed as unexplained chronic cough. Experts recommend that people who have this condition should go for regular specialist check-ups.

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