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Chronic cough is common
- Defined as a cough lasting more than 8 weeks
- Initial investigations should occur in the Community
- The majority of patients should be managed in the Community and in secondary care only if associated with significant pathology
- Cough can result from inflammation or irritation by any cause, of the upper or lower respiratory tract. Cough can also result from stimulation of the cough receptors in the lung directly
Who to refer:
Patients who have
- identified serious respiratory disease (cancer/interstitial disease/severe COPD/ bronchiectasis)
- identified respiratory disease with persistent symptoms despite appropriate treatment (asthma /COPD)
Suggested initial management
LRTI
- Amoxicillin 500mg tds for at least one week
- Clarithromycin 500mg bd for at least one week
COPD/Asthma
- Bronchial hyper reactivity: trial of prednisolone 40mg for least 5 days
GORD
- Appropriate PPI max dose for 3 months +/-
- Domperidone 10mg tds
Nasal/Sinus irritation or infection
- Nasal steroids for at least 2 months
Who not to refer:
Patients with identified:
- upper airways disease (rhinitis)
- GORD.
Patients with an established diagnosis with chronic cough being a common symptom :
- COPD(maximise treatment)
- interstitial lung disease
- bronchiectasis
- asthma (maximise treatment )
- post-infectious cough (which can last for up to one year).
How to refer:
SCI-Gateway to the appropriate OPD clinic
Investigations to be included with referral:
- chest x-ray
- spirometry with reversibility
- examination of neck and throat.
All diagnoses suspicious of cancer should be marked urgent
Note: weight loss, alteration of voice, shortness of breath, haemoptysis – refer urgently
Common causes are:
- post-viral cough (can last for a year or longer)
- post-infectious cough (airways or sinuses)
- an asthma syndrome
- rhinitis
- gastro oesophageal reflux (GORD)
- medication (particularly ACE-inhibitors)
- smoking
- heart failure
- occupational exposure to an irritant or an allergen.
Less common causes are:
- intrabronchial lesion
- severe bronchiectasis
- malignancy
- interstitial lung disease.
Non-specific and refractory cough
- Non-specific cough is a chronic cough not associated with any of the cough pointers or cough-related diagnosis. Investigations with chest x-rays and spirometry are normal
- Refractory cough is a cough that persists after therapy. Most patients with non-specific cough undergo spontaneous resolution or improvement
- In adults the management of these should include addressing patient stress and concern.
Conditions with specific remediable causes or usually good treatment response:
- protracted bacterial bronchitis
- angiotensin-converting enzyme inhibitor use
- asthma
- GORD
- obstructive sleep apnoea
- eosinophilic bronchitis
