Initial assessment of cough in adults
Initial assessment of cough in adults must include a thorough medical history, including review of medications, and examination to help identify triggers and determine the need for further investigations to exclude serious causes of cough. See also Management of chronic cough in adults for detail about specific investigations for chronic cough.
Consider additional investigations or referral to a relevant specialist if the patient has any of the alarm symptoms and findings listed in Alarm symptoms and findings in an adult with cough.
Consider additional investigations or referral to a relevant specialist if an adult with cough has any of the following symptoms and findings:
- haemoptysis
- smoker who:
- has a greater than 20 pack-year smoking history [NB1] and a new or altered cough
- is older than 45 years and has a new or altered cough, or cough with voice disturbance
- prominent dyspnoea, especially at rest or at night
- recurrent or chronic sputum production
- hoarseness
- systemic symptoms (eg fever, weight loss, vomiting, oedemaIrwin, 2018)
- GORD associated with weight loss, anaemia, haematemesis or melaena, vomiting, dysphagia (difficulty swallowing), odynophagia (painful swallowing)
- GORD not responding to empirical treatment
- recurrent pneumonia
- abnormal clinical respiratory examination
- abnormal chest X-ray.
GORD = gastro-oesophageal reflux disease
NB1: Pack years is calculated using the formula: (years of smoking × cigarettes per day) / 20; see also here for an online calculator.
For a patient with a chronic cough that has no identifiable cause or is refractory to treatment of identifiable causes, refer to a multidisciplinary cough clinic for assessment (or respiratory specialist if a clinic is not accessible)Gibson, 2016. See Chronic unexplained cough.
For detailed advice on diagnosis and assessment of cough, see the American College of Chest Physicians (CHEST) guidelines available here.