A prospective evaluation of esophageal testing and a double-blind, randomized study of omeprazole in a diagnostic and therapeutic algorithm for chronic cough. Ours TM, Kavuru MS, Schilz RJ, Richter JE. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background. Gonzales R, Bartlett JG, Besser RE, Cooper RJ, Hickner JM, Hoffman JR, et al. Pediatric allergic rhinitis and comorbid disorders. New York: McGraw-Hill, Health Professions Division, 1996:581–600. Goodman & Gilman’s The pharmacological basis of therapeutics. Histamine, bradykinin and their antagonists. The role of sinus imaging in the treatment of chronic cough in adults. Diagnosis and management of early lung cancer. Occupational and environmental causes of bronchogenic carcinoma. Nonresolving or slowly resolving pneumonia. Bronchiectasis: the “other” obstructive lung disease. New York: McGraw-Hill, Health Professions Division, 1996:733–58. Haber LR, Waseem M, Basnight LL, Burton DS, Barron S, Spitzmiller E. A pathogenic triad in chronic cough: asthma, postnasal drip syndrome, and gastroesophageal reflux disease. Palombini BC, Villanova CA, Araujo E, Gastal OL, Alt DC, Stolz DP, et al. Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause. Symptom research on chronic cough: a historical perspective. A consensus panel report of the American College of Chest Physicians. Managing cough as a defense mechanism and as a symptom. Irwin RS, Boulet LP, Cloutier MM, Fuller R, Gold PM, Hoffstein V, et al. Congenital conditions, cystic fibrosis, and immune disorders are possible diagnoses in children with chronic cough and recurrent infection. Foreign body aspiration should be considered in young children. Respiratory tract infections, asthma, and gastroesophageal reflux disease are the most common causes of chronic cough in children. However, a CD4 + cell count can help determine the potential for opportunistic infections in immunocompromised patients. The approach to diagnosing chronic cough in immunocompromised patients and children is similar to the approach in immunocompetent adults. If the cause of chronic cough remains unclear, high-resolution computed tomographic scanning of the chest, bronchoscopy, and referral to a pulmonary specialist may be indicated. Gastroesophageal reflux disease usually is diagnosed based on the symptoms and after a trial of therapy. Pulmonary function testing with a methacholine challenge is the preferred test for confirming the diagnosis of asthma. If postnasal drip syndrome is suspected, a trial of a decongestant and a first-generation antihistamine is warranted. Postnasal drip syndrome, asthma, and gastroesophageal reflux disease are the most likely causes of chronic cough in adults. If cough persists, a chest radiograph should be ordered to rule out malignancy and other serious conditions.

Patients who develop chronic cough in association with angiotensin-converting enzyme inhibitor therapy should be switched to an agent from another drug class. Several clinical algorithms to evaluate chronic cough are presented.Patients with chronic cough should avoid exposure to irritants that can trigger cough, and those who smoke should stop smoking. The possibility of a hypersensitive cough reflex response has been proposed to explain these cases. There are some coughs that seem refractory despite an extensive work-up. Treating the underlying cause(s) resolves cough in most instances. Many patients have more than one reason for chronic cough. Upper airway cough syndrome, asthma, eosinophilic bronchitis, and gastroesophageal reflux disease account for most chronic cough after excluding smoking, angiotensin-converting enzyme inhibitor use, and chronic bronchitis. Herein, the anatomy and physiology of the cough reflex are reviewed. A protracted cough can negatively affect one’s quality of life by causing anxiety, physical discomfort, social isolation, and personal embarrassment. Cough persisting beyond 8 weeks (ie, chronic cough) is one of the most common reasons for an outpatient visit.

Persistent nocturnal cough