Cough Diagnosis and Management

Introduction to Cough Causes

The American Thoracic Society recommends that the causes of cough in adults be classified based on duration, with acute cough (<3 weeks) being predominantly viral respiratory infections, subacute cough (3-8 weeks) being mainly postinfectious, and chronic cough (>8 weeks) being most commonly caused by upper airway cough syndrome (UACS), asthma, gastroesophageal reflux disease (GERD), and nonasthmatic eosinophilic bronchitis 1, 2

The American College of Chest Physicians suggests that viral upper respiratory tract infections account for the vast majority of acute cough cases, with exacerbations of underlying asthma or COPD also being a consideration 2, 1
The presence of red flags such as hemoptysis, severe dyspnea, chest pain, high fever, or signs of respiratory distress requires immediate evaluation 5

The European Respiratory Society notes that postinfectious cough is the leading cause of subacute cough, representing 48.4% of cases, while UACS, asthma, GERD, and nonasthmatic eosinophilic bronchitis are common causes of chronic cough 1, 5
The American Gastroenterological Association recommends that GERD be considered as a cause of chronic cough, even in the absence of heartburn, as up to 75% of GERD-related cough can be silent 10

The American College of Chest Physicians recommends a stepwise approach to diagnosing cough, including duration classification, screening for red flags, medication review, chest radiograph, and systematic evaluation or empiric treatment for common causes 1, 2
The European Respiratory Society suggests that a chest radiograph is mandatory for all chronic cough and acute cough with atypical features, to rule out malignancy, infection, or parenchymal disease 9, 6

The American Thoracic Society notes that demographics matter in cough diagnosis, with women, particularly middle-aged, having a higher prevalence and more sensitive cough reflex 3, 11
The American College of Chest Physicians recommends that timing provides diagnostic clues, with morning predominance suggesting UACS, cough when falling asleep that stops once asleep suggesting GERD, and night/early morning awakening suggesting asthma 3, 11