Chronic Cough: Evaluation and Management.

Area of Science:

• Pulmonology
• Gastroenterology
• Otolaryngology

Background:

• Chronic cough, defined as lasting over eight weeks in adults and four weeks in children, has multiple potential causes.
• Four primary conditions — upper airway cough syndrome, gastroesophageal reflux disease/laryngopharyngeal reflux disease, asthma, and nonasthmatic eosinophilic bronchitis — account for the majority of adult chronic cough cases.
• In children aged 6–14, asthma, protracted bacterial bronchitis, and upper airway cough syndrome are the most frequent culprits.

Purpose of the Study:

• To outline the common etiologies of chronic cough in adults and children.
• To guide clinical evaluation and treatment strategies for chronic cough.
• To identify potential causes of refractory chronic cough and suggest specialist referral.

Main Methods:

• Clinical evaluation, including spirometry when indicated.
• Empiric treatment initiation based on likely diagnoses.
• Chest radiography to exclude serious thoracic conditions.
• Consideration of medications (e.g., ACE inhibitors), environmental factors, and comorbidities (e.g., COPD, OSA).

Main Results:

• The four most common causes of chronic cough in adults are upper airway cough syndrome, GERD/LPRD, asthma, and nonasthmatic eosinophilic bronchitis.
• Asthma, protracted bacterial bronchitis, and upper airway cough syndrome are leading causes in children aged 6–14.
• Refractory cases may benefit from gabapentin, pregabalin, speech therapy, or referral to specialists.

Conclusions:

• A systematic approach to evaluating chronic cough, focusing on common etiologies, is essential for effective management.
• Timely diagnosis and targeted empiric treatment improve patient outcomes.
• Referral to specialists and adjunctive therapies may be necessary for refractory chronic cough.