GP · respiratory-health
Chronic cough
Also known as Chronic cough assessment · Persistent cough · Refractory chronic cough
GP-fellowship guide to chronic cough in adults: the ICHD-style definition of more than eight weeks, systematic evaluation through upper airway cough syndrome, asthma and GORD, ACE-inhibitor cough (RR 2.21 vs placebo), red flags (smoker over 40, haemoptysis, weight loss), Cochrane null result for PPI trials, refractory chronic cough and cough hypersensitivity concept, gabapentin evidence, speech pathology therapy efficacy, and when to refer.
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Red flags
- Smoker aged over 40 with new persistent cough needs CXR and consideration of lung cancer screening — never label as post-infectious without imaging
- Haemoptysis with chronic cough requires CXR at minimum; consider bronchoscopy if CXR is normal but suspicion persists
- Unintentional weight loss plus chronic cough mandates investigation for malignancy or tuberculosis
- ACE-inhibitor cough affects up to 15% of patients; stop the drug before pursuing other causes
Overview
Chronic cough in adults lasts more than eight weeks. It accounts for a large proportion of respiratory referrals and has a structured diagnostic pathway: identify the cause, treat it, and only label it refractory once the common causes have been addressed. [1]
References6ShowHide
- [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
- [2]Gibson P, Wang G, McGarvey L, Vertigan AE, Altman KW, et al. Treatment of Unexplained Chronic Cough: CHEST Guideline and Expert Panel Report. Chest, 2016.PMID 26426314
- [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