A clinical review of chronic cough from a primary care perspective

Abstract

Chronic cough is a common problem for primary care physicians, with prevalence rates of up to 22%. The pathogenic triad of upper airway cough syndrome (UACS), asthma, and gastroesophageal reflux disease (GERD) are either solely or partly responsible for up to 95% of patients who present with chronic cough. The objectives of this article are to present a basic scientific overview of chronic cough and to provide a strategic and systematic management algorithm to primary care physicians to maximize efficacy and efficiency in the treatment of patients with chronic cough. An online PubMed search was initially used. Subsequently, evidence-based sources were referenced. These included the Cochrane Database of Systematic Reviews, Evidence-BasedMedicine.com, Medscape's Primary Care Practice Guidelines, and the National Guideline Clearinghouse. Articles reviewed had no timeline limitations and inclusion criteria included published textbooks, publications in professional medical journals, and national databases. Chest radiographs are indicated for all patients with chronic cough. Smoking and cough-inducing medications need to be addressed. Once these factors are eliminated, management strategies for UACS, asthma, nonasthmatic eosinophilic bronchitis, GERD, and laryngopharyngeal reflux are discussed. Treatment strategies include empiric treatment, definitive diagnostic testing, behavior modifications, and aggressive drug regimens. A strategic and systematic management approach needs to be used to ensure that the most accurate and most efficient diagnostic and therapeutic outcomes are achieved. The recommended step-wise treatment protocol for chronic cough is based on a combination of empiric, integrative, and additive therapeutic strategies.