Home
Issues
Aim & Scope
Open Access
Indexing
Why publish with us
Contact
Editorial Board
Instructions to Authors (PDF)
Manuscript Types
Manuscript Formatting
How to submit
Preprints
Authorship & COI
Principles of Transparency Checklist
Publication Ethics and Publication Malpractice Statement
CrossMark
Data Policies
REVIEW
The never-ending challenge of chronic cough in adults: A Review for the Clinician
1
Respiratory Medicine Department, Amalia Fleming General Hospital, Athens, Greece
2
Editorial Board Pneumon
Pneumon 2012;25(2):164-175
KEYWORDS
ABSTRACT
Despite progress in the understanding of the mechanisms and aetiology of cough, it remains an alarming and annoying symptom for both patients and physicians. Chronic cough lasting for more than 8 weeks is one of the main reasons for referral in primary or secondary health care and the first symptom of many pulmonary and extra-pulmonary conditions. Its aetiology usually includes environmental causes, including exposure to cigarette smoke and environmental pollution, and several disease entities, both respiratory and non-respiratory. The most common respiratory causes are chronic obstructive pulmonary disease (COPD), bronchiectasis, upper airway cough syndrome (UACS) due to a variety of rhinosinus diseases, asthma and non-asthmatic eosinophilic bronchitis. Non-respiratory causes of cough include the use of angiotensin-converting enzyme (ACE) inhibitor agents and gastro-oesophageal reflux disease. Chronic cough may be multi-factorial and only rarely is its cause not identified, leading to the diagnosis of idiopathic chronic cough. Chronic cough is a disturbing symptom that affects the health-related quality of life of the patients and presents a diagnostic and therapeutic challenge for the clinician. This review summarizes the current evidence on the aetiology and the diagnostic difficulties of chronic cough in adults, and provides an algorithmic approach, along with practical tips, for its management by the busy practicing clinician.
REFERENCES (99)
1.
Morbidity Statistics from General Practice: 4th National Study 1991– 1992. London: Her Majesty’s Stationery Office; 1995.
2.
Schappert SM. Ambulatory care visits of physician offices, hospital outpatient departments, and emergency departments: United States, 1995. Vital Health Stat 13 1997:1-38.
3.
Korpas J, Tomori Z. Cough and other respiratory reflexes. Basel; London: Karger; [Chichester] : [Distributed by Wiley]; 1979.
4.
Morice AH, Fontana GA, Sovijarvi AR, et al. The diagnosis and management of chronic cough. Eur Respir J 2004;24:481-92.
5.
Irwin RS, Madison JM. The diagnosis and treatment of cough. N Engl J Med 2000;343:1715-21.
6.
Chung KF, Pavord ID. Prevalence, pathogenesis, and causes of chronic cough. Lancet 2008;371:1364-74.
7.
Morice AH, McGarvey L, Pavord I. Recommendations for the management of cough in adults. Thorax 2006;61(Suppl 1):i1-24.
8.
Fujimura M, Kasahara K, Kamio Y, Naruse M, Hashimoto T, Matsuda T. Female gender as a determinant of cough threshold to inhaled capsaicin. Eur Respir J 1996;9:1624-6.
9.
Kastelik JA, Thompson RH, Aziz I, Ojoo JC, Redington AE, Morice AH. Sex-related differences in cough reflex sensitivity in patients with chronic cough. Am J Respir Crit Care Med 2002;166:961-4.
10.
Irwin RS, Baumann MH, Bolser DC, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest 2006;129:1S-23S.
11.
Morice AH, Fontana GA, Belvisi MG, et al. ERS guidelines on the assessment of cough. Eur Respir J 2007;29:1256-76.
12.
Irwin RS, Curley FJ, French CL. Chronic cough. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Am Rev Respir Dis 1990;141:640-7.
13.
Birring SS. New concepts in the management of chronic cough. Pulm Pharmacol Ther 2011;24:334-8.
14.
Sharpey-Schafer EP. The mechanism of syncope after coughing. Br Med J 1953;2:860-3.
15.
Comroe JH. The physiology of respiration. 2nd ed. ed. [S.l.]: Year Book Medical Pub; 1974.
16.
Schultz DD, Olivas GS. The use of cough cardiopulmonary resuscitation in clinical practice. Heart Lung 1986;15:273-82.
17.
Irwin RS. Complications of cough: ACCP evidence-based clinical practice guidelines. Chest 2006;129:54S-8S.
18.
French CT, Fletcher KE, Irwin RS. Gender differences in healthrelated quality of life in patients complaining of chronic cough. Chest 2004;125:482-8.
19.
Birring SS, Prudon B, Carr AJ, Singh SJ, Morgan MD, Pavord ID. Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ). Thorax 2003;58:339-43.
20.
Curley FJ, Irwin RS, Pratter MR, et al. Cough and the common cold. Am Rev Respir Dis 1988;138:305-11.
21.
French CL, Irwin RS, Curley FJ, Krikorian CJ. Impact of chronic cough on quality of life. Arch Intern Med 1998;158:1657-61.
22.
French CT, Irwin RS, Fletcher KE, Adams TM. Evaluation of a cough-specific quality-of-life questionnaire. Chest 2002;121:1123-31.
23.
Birring SS, Matos S, Patel RB, Prudon B, Evans DH, Pavord ID. Cough frequency, cough sensitivity and health status in patients with chronic cough. Respir Med 2006;100:1105-9.
24.
Leconte S, Ferrant D, Dory V, Degryse J. Validated methods of cough assessment: a systematic review of the literature. Respiration 2011;81:161-74.
26.
Brightling CE, Monterio W, Green RH, et al. Induced sputum and other outcome measures in chronic obstructive pulmonary disease: safety and repeatability. Respir Med 2001;95:999-1002.
27.
Smith J, Owen E, Earis J, Woodcock A. Cough in COPD: correlation of objective monitoring with cough challenge and subjective assessments. Chest 2006;130:379-85.
28.
Hsu JY, Stone RA, Logan-Sinclair RB, Worsdell M, Busst CM, Chung KF. Coughing frequency in patients with persistent cough: assessment using a 24 hour ambulatory recorder. Eur Respir J 1994;7:1246-53.
29.
Birring SS, Fleming T, Matos S, Raj AA, Evans DH, Pavord ID. The Leicester Cough Monitor: preliminary validation of an automated cough detection system in chronic cough. Eur Respir J 2008;31:1013-8.
30.
Vizel E, Yigla M, Goryachev Y, et al. Validation of an ambulatory cough detection and counting application using voluntary cough under different conditions. Cough 2010;6:3.
31.
Kelsall A, Decalmer S, McGuinness K, Woodcock A, Smith JA. Sex differences and predictors of objective cough frequency in chronic cough. Thorax 2009;64:393-8.
33.
Bickerman HA, Barach AL. The experimental production of cough in human subjects induced by citric acid aerosols; preliminary studies on the evaluation of antitussive agents. Am J Med Sci 1954;228:156-63.
34.
Bickerman HA, German E, Cohen BM, Itkin SE. The cough response of healthy human subjects stimulated by citric acid aerosol. II. Evaluation of antitussive agents. Am J Med Sci 1957;234:191-206.
35.
Midgren B, Hansson L, Karlsson JA, Simonsson BG, Persson CG. Capsaicin-induced cough in humans. Am Rev Respir Dis 1992;146:347-51.
36.
Prudon B, Birring SS, Vara DD, Hall AP, Thompson JP, Pavord ID. Cough and glottic-stop reflex sensitivity in health and disease. Chest 2005;127:550-7.
37.
O’Connell F, Thomas VE, Pride NB, Fuller RW. Capsaicin cough sensitivity decreases with successful treatment of chronic cough. Am J Respir Crit Care Med 1994;150:374-80.
38.
Davis SF, Sutter RW, Strebel PM, et al. Concurrent outbreaks of pertussis and Mycoplasma pneumoniae infection: clinical and epidemiological characteristics of illnesses manifested by cough. Clin Infect Dis 1995;20:621-8.
39.
Gilberg S, Njamkepo E, Du Chatelet IP, et al. Evidence of Bordetella pertussis infection in adults presenting with persistent cough in a french area with very high whole-cell vaccine coverage. J Infect Dis 2002;186:415-8.
40.
Buist AS, Nagy JM, Sexton GJ. The effect of smoking cessation on pulmonary function: a 30-month follow-up of two smoking cessation clinics. Am Rev Respir Dis 1979;120:953-7.
41.
Israili ZH, Hall WD. Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. A review of the literature and pathophysiology. Ann Intern Med 1992;117:234-42.
42.
Irwin RS, Corrao WM, Pratter MR. Chronic persistent cough in the adult: the spectrum and frequency of causes and successful outcome of specific therapy. Am Rev Respir Dis 1981;123:413-7.
43.
Pratter MR. Overview of common causes of chronic cough: ACCP evidence-based clinical practice guidelines. Chest 2006;129:59S-62S.
44.
Pratter MR, Brightling CE, Boulet LP, Irwin RS. An empiric integrative approach to the management of cough: ACCP evidencebased clinical practice guidelines. Chest 2006;129:222S-31S.
45.
Brightling CE, Pavord ID. Eosinophilic bronchitis: an important cause of prolonged cough. Ann Med 2000;32:446-51.
46.
Brightling CE, Ward R, Wardlaw AJ, Pavord ID. Airway inflammation, airway responsiveness and cough before and after inhaled budesonide in patients with eosinophilic bronchitis. Eur Respir J 2000;15:682-6.
47.
Chatkin JM, Ansarin K, Silkoff PE, et al. Exhaled nitric oxide as a noninvasive assessment of chronic cough. Am J Respir Crit Care Med 1999;159:1810-3.
48.
Pratter MR. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest 2006;129:63S-71S.
49.
Carney IK, Gibson PG, Murree-Allen K, Saltos N, Olson LG, Hensley MJ. A systematic evaluation of mechanisms in chronic cough. Am J Respir Crit Care Med 1997;156:211-6.
50.
Corrao WM, Braman SS, Irwin RS. Chronic cough as the sole presenting manifestation of bronchial asthma. N Engl J Med 1979;300:633-7.
51.
Pratter MR, Bartter T, Akers S, DuBois J. An algorithmic approach to chronic cough. Ann Intern Med 1993;119:977-83.
52.
Wongtim S, Mogmeud S, Limthongkul S, Chareonlap P, Udompanich V, Nuchprayoon C, et al. The role of the methacholine inhalation challenge in adult patients presenting with chronic cough. Asian Pac J Allergy Immunol 1997;15:9-14.
53.
Anthrakopoulos MV. Chronic or recurrent cough in children. Is it asthma? Pneumon 2003;16:271-84.
55.
Gibson PG, Fujimura M, Niimi A. Eosinophilic bronchitis: clinical manifestations and implications for treatment. Thorax 2002;57:178-82.
56.
McGarvey LP, Forsythe P, Heaney LG, MacMahon J, Ennis M. Bronchoalveolar lavage findings in patients with chronic nonproductive cough. Eur Respir J 1999;13:59-65.
57.
Niimi A, Amitani R, Suzuki K, Tanaka E, Murayama T, Kuze F. Eosinophilic inflammation in cough variant asthma. Eur Respir J 1998;11:1064-9.
58.
Dicpinigaitis PV, Dobkin JB, Reichel J. Antitussive effect of the leukotriene receptor antagonist zafirlukast in subjects with cough-variant asthma. J Asthma 2002;39:291-7.
59.
Bateman ED, Hurd SS, Barnes PJ, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 2008;31:143-78.
60.
Moraitaki P, Papamichail D, Georgatou N. Severe Asthma: Definitions, risk factors and phenotype characterization. Pneumon 2010;23:276-92.
61.
Gibson PG, Dolovich J, Denburg J, Ramsdale EH, Hargreave FE. Chronic cough: eosinophilic bronchitis without asthma. Lancet 1989;1:1346-8.
62.
Gibson PG, Hargreave FE, Girgis-Gabardo A, Morris M, Denburg JA, Dolovich J. Chronic cough with eosinophilic bronchitis: examination for variable airflow obstruction and response to corticosteroid. Clin Exp Allergy 1995;25:127-32.
63.
Cockcroft DW, Murdock KY, Berscheid BA, Gore BP. Sensitivity and specificity of histamine PC20 determination in a random selection of young college students. J Allergy Clin Immunol 1992;89:23-30.
64.
Bakakos P, Schleich F, Alchanatis M, Louis R. Induced sputum in asthma: from bench to bedside. Curr Med Chem 2011;18:1415- 22.
65.
Smith AD, Cowan JO, Brassett KP, et al. Exhaled nitric oxide: a predictor of steroid response. Am J Respir Crit Care Med 2005;172:453-9.
66.
Oh MJ, Lee JY, Lee BJ, Choi DC. Exhaled nitric oxide measurement is useful for the exclusion of nonasthmatic eosinophilic bronchitis in patients with chronic cough. Chest 2008;134:990-5.
67.
Prieto L, Ferrer A, Ponce S, Palop J, Marin J. Exhaled nitric oxide measurement is not useful for predicting the response to inhaled corticosteroids in subjects with chronic cough. Chest 2009;136:816-22.
68.
Kostikas K, Minas M, Papaioannou AI, Papiris S, Dweik RA. Exhaled nitric oxide in asthma in adults: the end is the beginning? Curr Med Chem 2011;18:1423-31.
69.
Birring SS. Controversies in the evaluation and management of chronic cough. Am J Respir Crit Care Med 2011;183:708-15.
70.
Irwin RS. Chronic cough due to gastroesophageal reflux disease: ACCP evidence-based clinical practice guidelines. Chest 2006;129:80S-94S.
71.
Moayyedi P, Talley NJ. Gastro-oesophageal reflux disease. Lancet 2006;367:2086-100.
72.
Mello CJ, Irwin RS, Curley FJ. Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause. Arch Intern Med 1996;156:997-1003.
73.
Remacle M, Lawson G. Diagnosis and management of laryngopharyngeal reflux disease. Curr Opin Otolaryngol Head Neck Surg 2006;14:143-9.
74.
Irwin RS, French CL, Curley FJ, Zawacki JK, Bennett FM. Chronic cough due to gastroesophageal reflux. Clinical, diagnostic, and pathogenetic aspects. Chest 1993;104:1511-7.
75.
Irwin RS, Madison JM. The persistently troublesome cough. Am J Respir Crit Care Med 2002;165:1469-74.
76.
Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA. Gastro-oesophageal reflux treatment for prolonged nonspecific cough in children and adults. Cochrane Database Syst Rev 2006:CD004823.
77.
Faruqi S, Molyneux ID, Fathi H, Wright C, Thompson R, Morice AH. Chronic cough and esomeprazole: a double-blind placebocontrolled parallel study. Respirology 2011.
78.
Ford CN. Evaluation and management of laryngopharyngeal reflux. JAMA 2005;294:1534-40.
79.
Berkin KE, Ball SG. Cough and angiotensin converting enzyme inhibition. Br Med J (Clin Res Ed) 1988;296:1279.
80.
Dicpinigaitis PV. Angiotensin-converting enzyme inhibitorinduced cough: ACCP evidence-based clinical practice guidelines. Chest 2006;129:169S-73S.
81.
Kwon NH, Oh MJ, Min TH, Lee BJ, Choi DC. Causes and clinical features of subacute cough. Chest 2006;129:1142-7.
82.
Birring SS, Ing AJ, Chan K, et al. Obstructive sleep apnoea: a cause of chronic cough. Cough 2007;3:7.
83.
Sundar KM, Daly SE, Pearce MJ, Alward WT. Chronic cough and obstructive sleep apnea in a community-based pulmonary practice. Cough 2010;6:2.
84.
Chan KK, Ing AJ, Laks L, Cossa G, Rogers P, Birring SS. Chronic cough in patients with sleep-disordered breathing. Eur Respir J 2010;35:368-72.
85.
Birring SS, Passant C, Patel RB, Prudon B, Murty GE, Pavord ID. Chronic tonsillar enlargement and cough: preliminary evidence of a novel and treatable cause of chronic cough. Eur Respir J 2004;23:199-201.
86.
Lewis M, McClay JE, Schochet P. Lingual tonsillectomy for refractory paroxysmal cough. Int J Pediatr Otorhinolaryngol 2000;53:63-6.
87.
Ogawa H, Fujimura M, Takeuchi Y, Makimura K. The importance of basidiomycetous fungi cultured from the sputum of chronic idiopathic cough: a study to determine the existence of recognizable clinical patterns to distinguish CIC from non-CIC. Respir Med 2009;103:1492-7.
88.
Ogawa H, Fujimura M, Takeuchi Y, Makimura K. Efficacy of itraconazole in the treatment of patients with chronic cough whose sputa yield basidiomycetous fungi-fungus-associated chronic cough (FACC). J Asthma 2009;46:407-12.
89.
Irwin RS. Unexplained cough in the adult. Otolaryngol Clin North Am 2010;43:167-80, xi-xii.
90.
Haque RA, Usmani OS, Barnes PJ. Chronic idiopathic cough: a discrete clinical entity? Chest 2005;127:1710-3.
91.
Birring SS, Brightling CE, Symon FA, Barlow SG, Wardlaw AJ, Pavord ID. Idiopathic chronic cough: association with organ specific autoimmune disease and bronchoalveolar lymphocytosis. Thorax 2003;58:1066-70.
92.
Morice AH. The cough hypersensitivity syndrome: a novel paradigm for understanding cough. Lung 2010;188 Suppl 1:S87-90.
93.
Mund E, Christensson B, Gronneberg R, Larsson K. Noneosinophilic CD4 lymphocytic airway inflammation in menopausal women with chronic dry cough. Chest 2005;127:1714-21.
94.
McGarvey LP, Carton C, Gamble LA, et al. Prevalence of psychomorbidity among patients with chronic cough. Cough 2006;2:4.
95.
Birring SS, Murphy AC, Scullion JE, Brightling CE, Browning M, Pavord ID. Idiopathic chronic cough and organ-specific autoimmune diseases: a case-control study. Respir Med 2004;98:242-6.
96.
Birring SS, Parker D, Brightling CE, Bradding P, Wardlaw AJ, Pavord ID. Induced sputum inflammatory mediator concentrations in chronic cough. Am J Respir Crit Care Med 2004;169:15-9.
97.
Morice AH, Menon MS, Mulrennan SA, et al. Opiate therapy in chronic cough. Am J Respir Crit Care Med 2007;175:312-5.
98.
Yousaf N, Monteiro W, Parker D, Matos S, Birring S, Paord ID. Long-term low-dose erythromycin in patients with unexplained chronic cough: a double-blind placebo controlled trial. Thorax 2010;65:1107-10.
99.
Vertigan AE, Theodoros DG, Gibson PG, Winkworth AL. Efficacy of speech pathology management for chronic cough: a randomised placebo controlled trial of treatment efficacy. Thorax 2006;61:1065-9.
Share
RELATED ARTICLE
| eISSN: | 1791-4914 |
| ISSN: | 1105-848X |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
