Cough is one of the most common presenting symptom in primary practice. Sub-acute cough is defined as cough persisting for 3-8 weeks, and chronic cough as that persisting for more than 8 weeks in adults. Chronic cough in children has been defined as the presence of cough every day for 4 weeks or more. Sub-acute cough is most often self-limiting, but chronic cough may provide significant challenges for effective evaluation and management. The difficulty is in determining the cause of cough, because some 'aetiologies' 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 aged ≤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. Detailed recommendations regarding diagnostic algorithms and therapeutic trials for children may also differ from those for adults.
Non-targeted cough suppressant therapy is rarely effective for chronic cough.
- Upper airway cough syndrome (UACS; postnasal drip)
- Gastro-oesophageal reflux disease (GORD)
- Non-asthmatic eosinophilic bronchitis (NAEB)
- Chronic bronchitis/COPD
- Angiotensin-converting enzyme inhibitor (ACE inhibitor)
- Post-infectious cough
- Bordetella pertussis infection
- Lung cancer
- Bronchiectasis and chronic suppurative lung disease
- Interstitial pulmonary fibrosis
- Tuberculosis (TB)
- Zenker’s diverticulum
- Thoracic aortic aneurysm (TAA)
- Foreign body
- Hypersensitivity pneumonitis
- Recurrent aspiration
- Tropical filarial pulmonary eosinophilia
- Somatic cough syndrome (psychogenic cough)
Tomasz J. Kuzniar, MD, PhD
Clinical Assistant Professor of Medicine
University of Chicago
Division of Pulmonary and Critical Care Medicine
North Shore University Health System
TJK is the author of an article cited in this topic.
Dr Tomasz J. Kuzniar would like to gratefully acknowledge Dr Timothy I. Morgenthaler, a previous contributor to this topic.
TIM declares that he has no competing interests.
Nawal Lutfiyya, MD
Director of Research
Family and Community Medicine
University of Illinois at Chicago
NL declares that she has no competing interests.
Graeme Currie, MD
Consultant Chest Physician
Aberdeen Royal Infirmary
GC declares that he has no competing interests.
- European Respiratory Society guidelines for the diagnosis of asthma in adults
- ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease
Peak flow measurement animated demonstrationMore videos
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer