Evaluation and Management of Deep Breathing Causing Cough

Initial Assessment and Mandatory Testing

The American College of Chest Physicians recommends obtaining a focused medical history, including medication review, to identify potential causes of cough, such as ACE inhibitor use, which is a common and reversible cause 1, 2
Smoking status is a critical factor requiring cessation counseling, as active smoking can exacerbate underlying conditions 2
A chest radiograph is required to rule out pneumonia, malignancy, structural abnormalities, or infiltrates, and spirometry with bronchodilator testing should be performed to assess for asthma or obstructive lung disease 1, 3, 4

The American College of Chest Physicians recommends sequential and additive empiric treatment targeting the most common causes, starting with upper airway cough syndrome (UACS) treatment using an oral first-generation antihistamine/decongestant combination 2
If cough persists after UACS treatment, bronchoprovocation challenge testing should be performed to assess airway hyperresponsiveness, and an empiric trial of combination therapy with inhaled corticosteroids, inhaled β-agonists, or oral leukotriene inhibitors may be initiated 2, 3
If UACS and asthma have been eliminated or treated without resolution, induced sputum testing for eosinophils should be requested to diagnose eosinophilic bronchitis, and an empiric trial of corticosteroids may be considered 2, 4

The American College of Chest Physicians advises against relying solely on spirometry to diagnose asthma, as cough-variant asthma frequently presents with normal spirometry but positive bronchoprovocation testing 3
Referral to a cough specialist is indicated when the condition remains undiagnosed after systematic evaluation of UACS, asthma, eosinophilic bronchitis, and GERD 2, 3