Management of Chronic Cough in Low-Risk Patients

Initial Evaluation and Treatment

The American College of Chest Physicians recommends that patients with subacute postinfectious cough (3-8 weeks) should be managed in primary care with empiric treatment before considering specialty referral 1, 2
Inhaled ipratropium bromide is recommended as first-line therapy for subacute postinfectious cough, with the addition of first-generation antihistamine/decongestant combination if upper airway symptoms are present 2, 3
The American College of Radiology suggests that chest radiography should be obtained to exclude structural abnormalities, malignancy, or interstitial lung disease in patients with chronic cough 4

The American College of Chest Physicians recommends referral to pulmonology when the cough persists beyond 8 weeks despite systematic empiric treatment of common causes, or when initial chest radiography reveals abnormalities requiring specialist evaluation 1, 2
Patients with abnormal chest radiography, such as masses, infiltrates, lymphadenopathy, or interstitial changes, should be referred to pulmonology immediately 5, 4
The American College of Chest Physicians also recommends referral to pulmonology for patients with suspected interstitial lung disease based on clinical features or radiographic findings 5

Patients with increased lung cancer risk, such as current or former smokers, those over 55, or those with significant exposure history, should be referred to pulmonology earlier for evaluation 4
Immunocompromised patients, where opportunistic infections or malignancy are more likely, should also be referred to pulmonology earlier 5