Chronic cough: A guide to evaluation and management

• The most effective management is specific therapy directed at the underlying cause, which results in a positive response in more than 80% of patients. Therefore, a careful assessment to identify the cause of chronic cough is important. • A chest x-ray should be taken early in the clinical investagation of chronic cough. • The three most common causes of chronic cough when chest x-rays are normal are postnasal discharge, bronchial asthma and occult gastro-oesophageal reflux. • Remember that cough may be the sole manifestation of occult reflux or asthma. • Causes of chronic cough can coexist. If one cause seems likely, this should be treated; if multiple causes seem likely and important, treatment should be directed at each. • Referral to a thoracic physician should be considered if the patient's x-ray is abnormal, if the x-ray is normal but there is no response to first line therapy over three to four weeks, of if serious symptoms exist (e.g. haemoptysis).