Evaluation of chronic cough

Cough is one of the most common presenting symptom in primary practice.[1]Hermer L, Kang K, Rui P, et al. National ambulatory medical care survey - community health centers: 2014 state and national summary tables. 2019 [internet publication]. https://www.cdc.gov/nchs/data/ahcd/namcs_summary/2014_namcs_chc_web_tables-508.pdf Subacute cough is defined as cough persisting for 3-8 weeks, and chronic cough as that persisting for more than 8 weeks in adults.[2]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 Jan;153(1):196-209. http://journal.chestnet.org/article/S0012-3692(17)32918-5/fulltext http://www.ncbi.nlm.nih.gov/pubmed/29080708?tool=bestpractice.com [3]Morice AH, Millqvist E, Bieksiene K, et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J. 2020 Jan;55(1):1901136. https://erj.ersjournals.com/content/55/1/1901136.long http://www.ncbi.nlm.nih.gov/pubmed/31515408?tool=bestpractice.com Chronic cough in children has been defined as the presence of cough every day for 4 weeks or more.[4]Chang AB, Oppenheimer JJ, Irwin RS, et al. Managing chronic cough as a symptom in children and management algorithms: CHEST guideline and expert panel report. Chest. 2020 Jul;158(1):303-29. https://www.doi.org/10.1016/j.chest.2020.01.042 http://www.ncbi.nlm.nih.gov/pubmed/32179109?tool=bestpractice.com Subacute cough is most often self-limited, but chronic cough may provide significant challenges for effective evaluation and management. The difficulty is in determining the cause of cough, because some "etiologies" are syndromes without accurate diagnostic tests. The cause is determined instead by typical historical features, elimination of alternative causes, and response to targeted therapies (therapeutic trials serve as tests). Nonetheless, a careful history and examination, followed by carefully selected therapeutic trials and/or diagnostic evaluations, may satisfactorily resolve cough in over 90% of cases.

However, for children ages ≤14 years, common causes of chronic cough may be different to those in adults; the child’s age, cough characteristics, clinical history, and geographical setting should be taken into account.[4]Chang AB, Oppenheimer JJ, Irwin RS, et al. Managing chronic cough as a symptom in children and management algorithms: CHEST guideline and expert panel report. Chest. 2020 Jul;158(1):303-29. https://www.doi.org/10.1016/j.chest.2020.01.042 http://www.ncbi.nlm.nih.gov/pubmed/32179109?tool=bestpractice.com Detailed recommendations regarding diagnostic algorithms and therapeutic trials for children may also differ from those for adults.[4]Chang AB, Oppenheimer JJ, Irwin RS, et al. Managing chronic cough as a symptom in children and management algorithms: CHEST guideline and expert panel report. Chest. 2020 Jul;158(1):303-29. https://www.doi.org/10.1016/j.chest.2020.01.042 http://www.ncbi.nlm.nih.gov/pubmed/32179109?tool=bestpractice.com

Nontargeted cough suppressant therapy is rarely effective for chronic cough.