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Chronic cough

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Cough which lasts for more than 8 weeks in duration.

A heightened cough reflex has been suggested as the primary abnormality (1).

According to epidemiological surveys of the general population, persistent cough has been reported in 16% of the population in south-east England

  • it is commoner in females and obese people
  • responsible for 10% of respiratory referrals to secondary care (1)

Most patients present with a dry or minimally productive cough but in some, there can be disabling symptoms associated with significant impairment in quality of life:

  • physical - complains of musculoskeletal chest pains, sleep disturbance, and hoarse voice
  • psychological - depressive symptoms and worry about serious underlying diseases such as cancer and tuberculosis
  • social - difficulty in relationships, avoidance of public places, and disruption of employment (1)

A detailed patient history should be obtained in order to identify any initiating event. Inquire about:

  • angiotensin-converting enzyme (ACE) inhibitor
  • smoking - which appears to be dose-related with cough changing in character when smoking is discontinued
  • characteristics of cough
    • sudden onset may be associated with foreign body aspiration
    • sputum production suggests primary pulmonary pathology
    • cough which abates overnight may be due to reflux
    • coughing which wakes the patient up may be due to asthma, infection, or heart failure
    • a typical "honking" or "barking" quality, disappears with sleep and is not awakened by cough - may be psychogenic or habitual cough
  • clinical features of an underlying disease - COPD, asthma, bronchiectasis, lung cancer
  • occupation - which might reveal workplace sensitisers
    • dust/chemical exposure at home
  • cough on eating and postprandially, when talking on the telephone, laughing, or singing - may indicate reflux cough
  • family history - chronic cough may be familial

Investigations carried out in primary care include:

  • chest radiographs - should be done in all patients with chronic cough and those with acute cough demonstrating atypical symptoms
  • spirometry - should be performed in all patients with chronic cough (1)


  1. Morice AH et al. Recommendations for the management of cough in adults. Thorax. 2006;61 Suppl 1:i1-24

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