Management of chronic cough in adults

For all adults with chronic cough, perform an examination and take a thorough medical history, including questioning about nasal symptoms such as sneezing, nasal obstruction, and upper airway cough syndrome (previously called postnasal drip). In addition, perform spirometry and chest X-ray, and order a fractional exhaled nitric oxide (FeNO) test to look for evidence of airway inflammation (if possible); FeNO is commonly measured in specialist respiratory laboratories.

To effectively manage chronic cough, both the trigger and upper airway hypersensitivity need to be addressed.

Identify the trigger(s) of chronic cough (the condition or irritant causing cough); see Common or important causes of chronic cough in adults . Treat any underlying conditions, and avoid irritants, if possible. For information about proton pump inhibitors for gastro-oesophageal reflux disease (GORD)–related cough, see here. Inhaled corticosteroids should only be trialled if clinical evidence of asthma is present; see here. Antibiotics should only be used for chronic cough in patients with an identified bacterial cause.

Regardless of the trigger, cough may become self-perpetuating because the laryngeal nerves become hypersensitive. In upper airway hypersensitivity, the patient coughs in response to a trigger that would not normally cause cough (eg odours, talking). To manage upper airway hypersensitivity, educate patients about environmental factors that may be contributing to or worsening their cough. For many patients with chronic dry cough, vocal hygiene Gibson, 2016 is useful to break the self-perpetuating cycle and improve cough severity. For patients with chronic productive cough, strategies to facilitate sputum clearance may be useful.

For a summary of the evidence for over-the-counter and complementary therapies for cough, see Treatment of acute cough in adults.

Consider referring patients with severe or intractable chronic cough to a multidisciplinary cough clinic (or respiratory specialist if a clinic is not accessible) for assessment.

See Cough in palliative care for management advice in palliative care situations.