GP KFPs / SAQs · respiratory-health
Chronic cough — KFP-style written assessment
KFP-style staged scenarios on chronic cough: systematic evaluation of the three commonest causes, ACE-inhibitor cough, PPI trial limits per Cochrane null result, red flags requiring imaging, and refractory chronic cough management with speech pathology and gabapentin.
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Target exams
RACGP KFPRACGP AKTMRCGP AKT
Prompt
Chronic cough: more than eight weeks — find the cause before labelling it refractory; stop the ACEI first; do not rely on PPI alone
KFP 1 (10 marks)
A 52-year-old woman presents with a persistent dry cough for ten weeks. She takes ramipril 5 mg daily for hypertension. She has no weight loss, no haemoptysis, and does not smoke. [4]
- What is the most likely cause of her cough? (2) [4]
- What is your immediate management? (4) [4]
- If her cough persists after stopping the drug, how long should you wait and what would you investigate next? (4) [1]
Model answers
- ACE-inhibitor-induced cough. The pooled relative risk versus placebo was 2.21 (95% CI 2.05-2.39) across 135 RCTs and 45,420 patients. Up to 15% of ACEI users develop cough. [4]
- Stop ramipril and switch to an angiotensin receptor blocker (e.g., losartan). Cough may take up to four weeks to resolve after cessation. Do not pursue other investigations until this has been tried. [4]
- Wait at least four weeks after cessation. If cough persists, systematically evaluate the three commonest causes: upper airway cough syndrome (intranasal corticosteroid trial), asthma (spirometry ± bronchodilator reversibility), and GORD (conservative measures ± PPI trial). Order a CXR given her age. [1]
References5ShowHide
- [1]Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev, 2011.PMID 21249664
- [3]Irwin RS, French CL, Chang AB, et al. Classification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report. Chest, 2018.PMID 29080708
- [4]Ribeiro VV, Casmerides MCB, da Silva Reis ZMC, de Santana ÍV, do Carmo RD, Behlau M Efficacy of Speech-language Pathology Therapy in Chronic Cough: Systematic Review With Meta-analysis. J Voice, 2024.PMID 34969556
- [5]Hu Y, Liang L, Liu S, Kung JY, Banh HL Angiotensin-converting enzyme inhibitor induced cough compared with placebo, and other antihypertensives: A systematic review, and network meta-analysis. J Clin Hypertens (Greenwich), 2023.PMID 37417783
- [6]Salois JR, Heinle KL, Slovarp LJ, Jetté ME, Manchaiah V, et al. Internet-Based Behavioral Cough Suppression Therapy for Refractory Chronic Cough: A Randomized Controlled Trial. Am J Speech Lang Pathol, 2025.PMID 40811675