Cough

Abstract

In primary care, cough is the presenting symptom of over half of new patient consultations. The majority of these presentations to primary care are due to acute cough, a benign self-limiting illness caused by a myriad of viral pathogens, such as rhinovirus, adenovirus and the recently discovered metapneumovirus. Chronic cough has only recently been recognized as a separate syndrome and is separate from the cough of chronic obstructive pulmonary disease. The physical and psychological impacts of chronic cough on quality of life, such as cough syncope and social isolation are well described in the literature. In the absence of any obvious chest disease, it has three main causes: gastric reflux, asthma syndromes (cough-variant asthma and eosinophilic bronchitis), and rhinitis (upper airways cough syndrome in the USA). However, the majority of ‘difficult’ chronic cough cases have a typical clinical history pointing to reflux as the most likely cause. For the treatment of chronic cough, the main aim is either tackling the cause or suppressing this symptom.