Skip to main content
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 1996 Oct;72(852):594–598. doi: 10.1136/pgmj.72.852.594

Diagnosis and management of chronic persistent dry cough.

K F Chung 1, U G Lalloo 1
PMCID: PMC2398587  PMID: 8977940

Abstract

Cough is one of the commonest symptoms of lung disease and is a frequent problem encountered in general practice as well as in hospital practice. A wide range of disease processes may present with cough and definitive treatment depends on making an accurate diagnosis of the cause. A diagnostic work-up for patients with persistent dry cough is presented. The most common associated conditions are post-viral cough, asthma, rhinosinusitis (post-nasal drip or 'nasal catarrh') and gastro-oesophageal reflux. Treatment with angiotensin-converting enzyme inhibitors can also lead to a persistent dry cough. Specific treatment of the cause should control the cough, but this may not occur in all cases and in a sizeable proportion of patients, no associated cause can be found. An increased sensitivity of the cough reflex can be observed in patients with persistent dry cough. Symptomatic relief must be considered when the cough interferes with the patient's health and sleep but the most effective antitussive opiates cause sedation and may be addictive. Treatment of persistent dry cough remains a challenge in some patients and there is still scope for improvement in its diagnosis and effective therapy.

Full text

PDF
594

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. A double-blind multicenter group comparative study of the efficacy and safety of nedocromil sodium in the management of asthma. North American Tilade Study Group. Chest. 1990 Jun;97(6):1299–1306. doi: 10.1378/chest.97.6.1299. [DOI] [PubMed] [Google Scholar]
  2. Boulet L. P., Milot J., Boutet M., St Georges F., Laviolette M. Airway inflammation in nonasthmatic subjects with chronic cough. Am J Respir Crit Care Med. 1994 Feb;149(2 Pt 1):482–489. doi: 10.1164/ajrccm.149.2.8306050. [DOI] [PubMed] [Google Scholar]
  3. Braman S. S., Corrao W. M. Chronic cough. Diagnosis and treatment. Prim Care. 1985 Jun;12(2):217–225. [PubMed] [Google Scholar]
  4. Burrows B., Lebowitz M. D., Barbee R. A., Cline M. G. Findings before diagnoses of asthma among the elderly in a longitudinal study of a general population sample. J Allergy Clin Immunol. 1991 Dec;88(6):870–877. doi: 10.1016/0091-6749(91)90243-h. [DOI] [PubMed] [Google Scholar]
  5. Choudry N. B., Fuller R. W. Sensitivity of the cough reflex in patients with chronic cough. Eur Respir J. 1992 Mar;5(3):296–300. [PubMed] [Google Scholar]
  6. Corrao W. M., Braman S. S., Irwin R. S. Chronic cough as the sole presenting manifestation of bronchial asthma. N Engl J Med. 1979 Mar 22;300(12):633–637. doi: 10.1056/NEJM197903223001201. [DOI] [PubMed] [Google Scholar]
  7. Curley F. J., Irwin R. S., Pratter M. R., Stivers D. H., Doern G. V., Vernaglia P. A., Larkin A. B., Baker S. P. Cough and the common cold. Am Rev Respir Dis. 1988 Aug;138(2):305–311. doi: 10.1164/ajrccm/138.2.305. [DOI] [PubMed] [Google Scholar]
  8. Das R. M., Jeffrey P. K., Widdicombe J. G. The epithelial innervation of the lower respiratory tract of the cat. J Anat. 1978 May;126(Pt 1):123–131. [PMC free article] [PubMed] [Google Scholar]
  9. Di Pede C., Viegi G., Quackenboss J. J., Boyer-Pfersdorf P., Lebowitz M. D. Respiratory symptoms and risk factors in an Arizona population sample of Anglo and Mexican-American whites. Chest. 1991 Apr;99(4):916–922. doi: 10.1378/chest.99.4.916. [DOI] [PubMed] [Google Scholar]
  10. Fuller R. W., Choudry N. B. Increased cough reflex associated with angiotensin converting enzyme inhibitor cough. Br Med J (Clin Res Ed) 1987 Oct 24;295(6605):1025–1026. doi: 10.1136/bmj.295.6605.1025-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hargreaves M. R., Benson M. K. Inhaled sodium cromoglycate in angiotensin-converting enzyme inhibitor cough. Lancet. 1995 Jan 7;345(8941):13–16. doi: 10.1016/s0140-6736(95)91151-0. [DOI] [PubMed] [Google Scholar]
  12. Heino M., Juntunen-Backman K., Leijala M., Rapola J., Laitinen L. A. Bronchial epithelial inflammation in children with chronic cough after early lower respiratory tract illness. Am Rev Respir Dis. 1990 Feb;141(2):428–432. doi: 10.1164/ajrccm/141.2.428. [DOI] [PubMed] [Google Scholar]
  13. Hsu J. Y., Stone R. A., Logan-Sinclair R. B., Worsdell M., Busst C. M., Chung K. F. Coughing frequency in patients with persistent cough: assessment using a 24 hour ambulatory recorder. Eur Respir J. 1994 Jul;7(7):1246–1253. doi: 10.1183/09031936.94.07071246. [DOI] [PubMed] [Google Scholar]
  14. Ing A. J., Ngu M. C., Breslin A. B. Chronic persistent cough and clearance of esophageal acid. Chest. 1992 Dec;102(6):1668–1671. doi: 10.1378/chest.102.6.1668. [DOI] [PubMed] [Google Scholar]
  15. Ing A. J., Ngu M. C., Breslin A. B. Chronic persistent cough and gastro-oesophageal reflux. Thorax. 1991 Jul;46(7):479–483. doi: 10.1136/thx.46.7.479. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Ing A. J., Ngu M. C., Breslin A. B. Pathogenesis of chronic persistent cough associated with gastroesophageal reflux. Am J Respir Crit Care Med. 1994 Jan;149(1):160–167. doi: 10.1164/ajrccm.149.1.8111576. [DOI] [PubMed] [Google Scholar]
  17. Irwin R. S., Corrao W. M., Pratter M. R. Chronic persistent cough in the adult: the spectrum and frequency of causes and successful outcome of specific therapy. Am Rev Respir Dis. 1981 Apr;123(4 Pt 1):413–417. doi: 10.1164/arrd.1981.123.4.413. [DOI] [PubMed] [Google Scholar]
  18. Irwin R. S., Curley F. J., French C. L. Chronic cough. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Am Rev Respir Dis. 1990 Mar;141(3):640–647. doi: 10.1164/ajrccm/141.3.640. [DOI] [PubMed] [Google Scholar]
  19. Irwin R. S., Pratter M. R., Holland P. S., Corwin R. W., Hughes J. P. Postnasal drip causes cough and is associated with reversible upper airway obstruction. Chest. 1984 Mar;85(3):346–352. doi: 10.1378/chest.85.3.346. [DOI] [PubMed] [Google Scholar]
  20. Irwin R. S., Zawacki J. K., Curley F. J., French C. L., Hoffman P. J. Chronic cough as the sole presenting manifestation of gastroesophageal reflux. Am Rev Respir Dis. 1989 Nov;140(5):1294–1300. doi: 10.1164/ajrccm/140.5.1294. [DOI] [PubMed] [Google Scholar]
  21. Jack C. I., Calverley P. M., Donnelly R. J., Tran J., Russell G., Hind C. R., Evans C. C. Simultaneous tracheal and oesophageal pH measurements in asthmatic patients with gastro-oesophageal reflux. Thorax. 1995 Feb;50(2):201–204. doi: 10.1136/thx.50.2.201. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Katsumata U., Sekizawa K., Ujiie Y., Sasaki H., Takishima T. Bradykinin-induced cough reflex markedly increases in patients with cough associated with captopril and enalapril. Tohoku J Exp Med. 1991 Jun;164(2):103–109. doi: 10.1620/tjem.164.103. [DOI] [PubMed] [Google Scholar]
  23. McFadden E. R., Jr Exertional dyspnea and cough as preludes to acute attacks of bronchial asthma. N Engl J Med. 1975 Mar 13;292(11):555–559. doi: 10.1056/NEJM197503132921103. [DOI] [PubMed] [Google Scholar]
  24. Morice A. H., Lowry R., Brown M. J., Higenbottam T. Angiotensin-converting enzyme and the cough reflex. Lancet. 1987 Nov 14;2(8568):1116–1118. doi: 10.1016/s0140-6736(87)91547-9. [DOI] [PubMed] [Google Scholar]
  25. Nichol G., Nix A., Barnes P. J., Chung K. F. Prostaglandin F2 alpha enhancement of capsaicin induced cough in man: modulation by beta 2 adrenergic and anticholinergic drugs. Thorax. 1990 Sep;45(9):694–698. doi: 10.1136/thx.45.9.694. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. O'Connell F., Thomas V. E., Pride N. B., Fuller R. W. Capsaicin cough sensitivity decreases with successful treatment of chronic cough. Am J Respir Crit Care Med. 1994 Aug;150(2):374–380. doi: 10.1164/ajrccm.150.2.8049818. [DOI] [PubMed] [Google Scholar]
  27. Pepin J., Milord F., Guern C., Mpia B., Ethier L., Mansinsa D. Trial of prednisolone for prevention of melarsoprol-induced encephalopathy in gambiense sleeping sickness. Lancet. 1989 Jun 3;1(8649):1246–1250. doi: 10.1016/s0140-6736(89)92340-4. [DOI] [PubMed] [Google Scholar]
  28. Pratter M. R., Bartter T., Akers S., DuBois J. An algorithmic approach to chronic cough. Ann Intern Med. 1993 Nov 15;119(10):977–983. doi: 10.7326/0003-4819-119-10-199311150-00003. [DOI] [PubMed] [Google Scholar]
  29. WIDDICOMBE J. G. Receptors in the trachea and bronchi of the cat. J Physiol. 1954 Jan;123(1):71–104. doi: 10.1113/jphysiol.1954.sp005034. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. WYNDER E. L., LEMON F. R., MANTEL N. EPIDEMIOLOGY OF PERSISTENT COUGH. Am Rev Respir Dis. 1965 May;91:679–700. doi: 10.1164/arrd.1965.91.5.679. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES