Chronic cough: a practical approach to assessment and management.

Abstract

### Key learning points Cough is one of the most common symptoms that leads to a consultation in primary care.1 However, studies highlight that awareness of clinical guidelines on the management of cough among general practitioners (GPs) has been low and referral to specialist clinics may be premature.1,2 In this article, we review the management of adults with chronic cough in primary care and focus upon initial assessment and management strategies. Cough is a reflex action with a degree of voluntary and involuntary control. It is mediated by afferent sensory nerves (initiated by a wide variety of stimuli) resulting in forced expulsion against a closed glottis. Cough is arbitrarily defined as chronic when it lasts >8 weeks and can result from many conditions.3 Patients who have no clear cause after guideline-based assessment and investigation (see box 1), and who fail to respond to empirical treatments are usually labelled as having chronic idiopathic cough.4,5 It is important to differentiate chronic idiopathic cough from refractory chronic cough in which an explanation usually exists (eg, chronic obstructive pulmonary disease [COPD]) but the cough remains despite treatment of the underlying condition. Box 1: ### Chronic cough clinical guidelines