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Editorials |

Chronic Cough : Practical Considerations

Susan M. Harding, MD, FCCP
Author and Funding Information

Affiliations: Birmingham, AL
 ,  Dr. Harding is Associate Professor of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, and has been a consultant for Astra Zeneca LP.

Correspondence to: Susan M. Harding, MD, FCCP, Division of Pulmonary, Allergy, and Critical Care Medicine, 1900 University Blvd, THT Rm 215, University of Alabama at Birmingham, Birmingham, AL 35294; e-mail: sharding@uab.edu



Chest. 2003;123(3):659-660. doi:10.1378/chest.123.3.659
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Cough remains one of the most common complaints motivating patients to seek medical attention in the United States. Fortunately, we have 25 years of evidenced-based research to help us evaluate and treat even the most perplexing cases. Utilizing a diagnostic protocol allows the cause of cough to be identified in 88 to 100% of patients, and with appropriate therapy there is resolution of cough in up to 98% of patients.1 Several studies have supported the utility of the diagnostic protocol in patients with chronic persistent cough, not only in the academic tertiary care setting, but also in the community setting. Under the leadership of Dr. Richard Irwin, the American College of Chest Physicians (ACCP) developed an evidence-based consensus panel report2 in which diagnostic algorithms and appropriate treatment regimens were presented that target the underlying cause of cough. By definition, chronic persistent cough is a cough lasting for > 8 weeks in a nonsmoking, immunocompetent patient who has a normal chest radiograph finding, is not receiving therapy with an angiotensin-converting enzyme inhibitor, and has not been exposed to an environmental irritant. In this setting, the three most common causes of cough are postnasal drip (frequency, 41 to 58%), cough-variant asthma (frequency, 24 to 59%), and gastroesophageal reflux (GER) [frequency, 21 to 41%]. Cough-variant asthma and rhinosinus diseases can be dealt with by appropriate evaluation and treatment. Another compounding factor is that in approximately 20% of patients cough is due to more than one cause, making careful, persistent follow-up and further evaluation a requirement to ensure cough resolution.

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