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Chronic Cough

Chronic Cough is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Chronic cough is defined as a cough that persists for >8 weeks in adults.
  • In children, chronic cough is often defined as a cough of >4 weeks in duration.
  • Subacute cough describes a cough lasting 3 to 8 weeks.
  • Patients present because of fear of the causative illness (e.g., cancer), annoyance, self-consciousness, and hoarseness.
  • System(s) affected: gastrointestinal (GI), pulmonary

Epidemiology

  • Predominant age: all age groups
  • Predominant sex: male = female, with females more likely to seek out medical attention

Incidence
Persistent unexplained cough occurs in up to 10% of patients presenting with chronic cough and up to 46% referred to specialty cough clinics (1).

Prevalence
Chronic cough is one of the most common reasons for primary care visits.

Etiology and Pathophysiology

Varies with findings and disorders implicated

  • Often multiple etiologies, but most are related to bronchial irritation. Frequent etiologies (account for >90% of cases) in nonsmokers include the following:
    • Upper airway cough syndrome (UACS) and other upper airway abnormalities, including allergic and vasomotor rhinitis syndromes
    • Asthma
    • Gastroesophageal reflux disease (GERD)
  • Other causes:
    • ACE inhibitors
    • Chronic smoking or exposure to smoke or pollutants
    • Aspiration
    • Bronchiectasis
    • Infections (e.g., pertussis, tuberculosis)
    • Nonasthmatic eosinophilic bronchitis (NAEB)
    • Cystic fibrosis
    • Sleep apnea
    • Restrictive lung diseases
    • Neoplasms: bronchogenic or laryngeal
    • Psychogenic (habit cough)
  • Cough hypersensitivity syndrome defines a syndrome of cough with characteristic trigger symptoms not adequately explained by other medical conditions.
  • Etiologies of chronic cough in young children differ from those in older children and adults (2).

Risk Factors

Although various conditions may contribute to chronic cough, the main causes include smoking and pulmonary diseases.

Commonly Associated Conditions

Patients with UACS, asthma, and GERD may present with chronic cough as the only symptom and not the usual symptoms associated with the diagnoses.

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Citation

Stephens, Mark B., et al., editors. "Chronic Cough." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116131/all/Chronic_Cough.
Chronic Cough. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116131/all/Chronic_Cough. Accessed April 24, 2019.
Chronic Cough. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116131/all/Chronic_Cough
Chronic Cough [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116131/all/Chronic_Cough.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Chronic Cough ID - 116131 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116131/all/Chronic_Cough PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -