Content area
Full text
Chronic cough is estimated to affect 5% of the U.S. adult population (12.3 million individuals). 1 The American College of Chest Physicians (CHEST) defines chronic cough as a persistent cough lasting longer than 8 weeks in adults and 4 weeks in children. 2,3 According to the Centers for Disease Control and Prevention, cough of undifferentiated duration is the second most common reason that patients present to primary care ambulatory settings. 4 Chronic cough can negatively impact quality of life and daily activities, which can increase the risk of depression and anxiety. 5–7
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| The evaluation and treatment of chronic cough in adults should be based on the most common causes, including upper airway cough syndrome, asthma, nonasthmatic eosinophilic bronchitis, GERD, and laryngopharyngeal reflux. 14 | C | Clinical practice guidelines |
| For chronic refractory cough, physiotherapy and speech pathology therapy should be considered. 2,53–55 | B | RCT, systematic review, and clinical practice guidelines |
| A trial of a neuromodulator, such as gabapentin or amitriptyline, should be considered for chronic refractory cough. 2,56–58 | B | RCT, systematic review, and clinical practice guidelines |
| The evaluation and treatment of chronic cough in children should be based on the most common causes, including protracted bacterial bronchitis, asthma, bronchiectasis, upper airway cough syndrome, and GERD. 3,60–62 | C | Clinical practice guidelines |
GERD = gastroesophageal reflux disease; RCT = randomized controlled trial.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
ASSESSMENT OF CHRONIC COUGH
The initial assessment of chronic cough includes obtaining a comprehensive medical history, performing a physical examination, identifying triggers that may point to common causes (Table 1 2,3,8–13 ), and evaluating for red flags to rule out serious conditions (Table 2 14,15 ). Chest radiography and spirometry should be included in the initial workup if the history and physical examination do not identify an apparent cause. Initial treatment should be based on pertinent history and physical examination findings, and response to treatment should be assessed in 4 to 6 weeks. The evaluation and empiric treatment of chronic cough in adults should be based on the most common causes:...