Initial evaluation of the patient with
chronic cough (i.e., of more than eight weeks' duration) should include a focused history and physical examination, and in most patients, chest radiography. Patients who are taking an
angiotensin-converting enzyme inhibitor should switch to a medication from another
drug class. The most common causes of
chronic cough in adults are
upper airway cough syndrome,
asthma, and
gastroesophageal reflux disease, alone or in combination. If
upper airway cough syndrome is suspected, a trial of a
decongestant and a first-generation
antihistamine is warranted. The diagnosis of
asthma should be confirmed based on clinical response to empiric
therapy with inhaled
bronchodilators or
corticosteroids. Empiric treatment for
gastroesophageal reflux disease should be initiated in lieu of testing for patients with
chronic cough and reflux symptoms. Patients should avoid exposure to
cough-evoking irritants, such as cigarette
smoke. Further testing, such as high-resolution computed tomography, and referral to a pulmonologist may be indicated if the cause of
chronic cough is not identified. In children, a
cough lasting longer than four weeks is considered chronic. The most common causes in children are
respiratory tract infections,
asthma, and
gastroesophageal reflux disease. Evaluation of children with
chronic cough should include chest radiography and spirometry.