chapter  13
12 Pages

Systematic Evaluation of Chronic Cough

ByCaroline F. Everett, Alyn H. Morice

Chronic cough can be differentiated from acute cough by an arbitrary cutoff

of 8 weeks (1). This distinction is helpful in clinical practice as the etiology and epidemiology of chronic cough are quite different from those of acute

cough. However, when faced with a chronic cough patient, determining

which of the possible underlying causes is to blame can be far from easy.

Community-based data on chronic cough reveal a suboptimally managed

population whose median duration of cough is 6.5 years, despite a high rate

of medical consultations in both primary and secondary care (2). In con-

trast, data from specialist cough clinics, where a more systematic approach

to diagnosis and management is usually employed, support very high treatment success rates (3). This is because cough may arise from anywhere

along the distribution of the vagus nerve and therefore the possibility of dis-

ease in a variety of different systems must be considered in a logical and

structured way. Indeed, one of the important reasons for misdiagnosis of

chronic cough in both primary and secondary care is the failure to consider

common extrapulmonary causes (4).