In adults,
chronic cough is a nonproductive or productive
cough lasting longer than 8 weeks. Coughing is a reflex to clear the lungs and airways, but repetitive, long-term coughing can cause chronic irritation and
inflammation. Approximately 90% of
chronic cough diagnoses have common nonmalignant etiologies, including
upper airway cough syndrome,
asthma,
gastroesophageal reflux disease, and nonasthmatic eosinophilic
bronchitis. In addition to history and physical examination, initial evaluation for
chronic cough includes pulmonary function testing and chest x-ray to assess the lungs and heart and for fluid overload, and evaluate for
neoplasm or lymph node enlargement. If the patient has red flag symptoms, such as
fever,
weight loss,
hemoptysis, or recurrent
pneumonia, or has persistent symptoms despite optimal drug treatment, advanced imaging with chest computed tomography scan is indicated. Management of chronic
cough includes identifying and managing the underlying cause as outlined in the American College of Chest Physicians (CHEST) and European Respiratory Society (ERS) guidelines for
chronic cough. In diagnoses of refractory
chronic cough with uncertain etiology and a negative evaluation for life-threatening causes,
cough hypersensitivity syndrome should be considered and managed with
gabapentin or
pregabalin and a trial of
speech therapy.