Chronic Cough History & Physical

* Inflation Adjusted

Initial evaluation of a cough of more than eight weeks duration should include a focused history and physical examination, and chest x-ray Patients who are taking an angiotensin-converting enzyme inhibitor should switch to another drug class. The most common causes of chronic cough in adults are asthma, upper airway cough syndrome, and gastroesophageal reflux disease. If upper airway cough syndrome is suspected, a trial of a decongestant and an antihistamine is warranted. The diagnosis of asthma should be confirmed based on clinical response to empiric therapy. Empiric treatment for gastroesophageal reflux disease should be initiated in lieu of testing for patients with chronic cough and reflux.

Patients should avoid exposure to cough-evoking irritants. Further testing, such as high-resolution computed tomography, and referral to a pulmonologist is indicated if the cause of chronic cough is not identified. In children, a cough lasting longer than four weeks is considered chronic. The most common causes in children are asthma, respiratory tract infections, and reflux disease. Evaluation of children with chronic cough should include a chest x-ray and spirometry.