Evaluation of the Patient with Chronic Cough - American Family Physician

Differential Diagnosis of Chronic Cough Cough may be characterized as acute (lasting less than three weeks), subacute (lasting three to eight weeks), or chronic (persisting beyond eight weeks).2 Acute cough may develop because of viral upper respiratory tract infection (the most common cause), acute bacterial sinusitis, exacerbation of chronic obstructive pulmonary disease (COPD), allergic rhinitis, and environmental exposure.2 Subacute cough most often results from bacterial sinusitis or asthma; it also can occur after an infection (i.e., upper respiratory tract infection not accompanied by pneumonia).2,3 Subacute cough resolves without treatment. Pertussis may be acute or subacute.2 Chronic cough can have many causes, but only a few diseases account for most cases2,4 (Table 1).1,2,5-7 In adults, postnasal drip syndrome, C hronic cough is a common reason for physician visits in the United States and other industrialized nations.1-3 However, some patients with chronic cough fail to seek medical attention because of lack of concern or denial. This article presents a systematic, evidence-based approach to the evaluation of chronic cough. The approach is based on the results of prospective studies and an evidencebased practice guideline.1