Cough resident survival guide: Difference between revisions

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__NOTOC__
__NOTOC__
{{CMG}}; {{AE}} {{SaraH}}
{{CMG}}; {{AE}} {{SaraH}} {{Sara.Zand}}


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==Overview==
==Overview==
[[Cough]] is a defense mechanism  for preventation of [[irritation]] and [[aspiration ]] by clearing excessive secretion or [[foreign body]] from the [[airway]] and also it may spread [[infection]]. [[cough]] is the [[symptom]] of involving organs such as [[upper airway tract]], [[lung]], [[heart]], or [[gastrointestinal tract]]. Dependent on the duration of [[cough]], it can be categorized to three groups including  [[acute]], [[subacute]], [[chronic]]. Acute [[cough]] is the most common causes of seeking medical attention every year. Chronic [[cough]] may affect the quality of life and also may increases [[mortality]] based o underlying disorder. Assessment of [[life threatening]] causes of [[cough]] such as [[ obstructive airway disease]] or [[pulmonary embolism]] is of important.
[[Cough]] is a defense mechanism  for preventation of [[airway]] [[irritation]] or [[aspiration ]] by cleaning excessive secretion or [[foreign body]] from the [[airway]] and also it may spread [[infection]]. [[Cough]] is the [[symptom]] of involving [[organs]] such as [[upper airway tract]], [[lung]], [[heart]], or [[gastrointestinal tract]]. Dependent on the [[duration]] of [[cough]], it can be categorized to three groups including  [[acute]], [[subacute]], [[chronic]]. Acute [[cough]] is the most common causes of seeking medical attention every year. Chronic [[cough]] may affect the quality of life and also may increase [[mortality]] based on the underlying [[disorder]]. Assessment of the [[life threatening]] causes of [[cough]] such as [[ obstructive airway disease]] or [[pulmonary embolism]] is of important.


==Causes==
==Causes==
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* [[Allergic Rhinitis]]
* [[Allergic Rhinitis]]
* [[Asthma]]<ref name="pmid11716169">{{cite journal |vauthors=Janson C, Chinn S, Jarvis D, Burney P |title=Determinants of cough in young adults participating in the European Community Respiratory Health Survey |journal=Eur Respir J |volume=18 |issue=4 |pages=647–54 |date=October 2001 |pmid=11716169 |doi=10.1183/09031936.01.00098701 |url=}}</ref>
* [[Asthma]]<ref name="pmid11716169">{{cite journal |vauthors=Janson C, Chinn S, Jarvis D, Burney P |title=Determinants of cough in young adults participating in the European Community Respiratory Health Survey |journal=Eur Respir J |volume=18 |issue=4 |pages=647–54 |date=October 2001 |pmid=11716169 |doi=10.1183/09031936.01.00098701 |url=}}</ref>
* [[Bronchiectasis]]
* [[Bronchitis]]<ref name="pmid23204254">{{cite journal |vauthors=Kim V, Criner GJ |title=Chronic bronchitis and chronic obstructive pulmonary disease |journal=Am J Respir Crit Care Med |volume=187 |issue=3 |pages=228–37 |date=February 2013 |pmid=23204254 |pmc=4951627 |doi=10.1164/rccm.201210-1843CI |url=}}</ref>
* [[Gastroesophageal Reflux Disease]] ([[GERD]])
* [[Gastroesophageal Reflux Disease]] ([[GERD]])
* [[Post-nasal drip]]
* [[Post-nasal drip]]<ref name="pmid22577385">{{cite journal |vauthors=Sylvester DC, Karkos PD, Vaughan C, Johnston J, Dwivedi RC, Atkinson H, Kortequee S |title=Chronic cough, reflux, postnasal drip syndrome, and the otolaryngologist |journal=Int J Otolaryngol |volume=2012 |issue= |pages=564852 |date=2012 |pmid=22577385 |pmc=3332192 |doi=10.1155/2012/564852 |url=}}</ref>
* Medications' side effect
* [[Foreign body aspiration]]<ref name="AkelmaCizmeci2013">{{cite journal|last1=Akelma|first1=Ahmet Zulfikar|last2=Cizmeci|first2=Mehmet Nevzat|last3=Kanburoglu|first3=Mehmet Kenan|last4=Mete|first4=Emin|title=An Overlooked Cause of Cough in Children: Foreign Body Aspiration|journal=The Journal of Pediatrics|volume=163|issue=1|year=2013|pages=292–293|issn=00223476|doi=10.1016/j.jpeds.2012.12.089}}</ref>
**[[ACE inhibitor|ACE inhibitors]]
*[[ACE inhibitor|ACE inhibitors]]<ref name="pmid30664425">{{cite journal |vauthors=Yılmaz İ |title=Angiotensin-Converting Enzyme Inhibitors Induce Cough |journal=Turk Thorac J |volume=20 |issue=1 |pages=36–42 |date=January 2019 |pmid=30664425 |pmc=6340691 |doi=10.5152/TurkThoracJ.2018.18014 |url=}}</ref>
*[[Bronchitis]]<ref name="pmid31176801">{{cite journal |vauthors=Mac Aogáin M, Chotirmall SH |title=Bronchiectasis and cough: An old relationship in need of renewed attention |journal=Pulm Pharmacol Ther |volume=57 |issue= |pages=101812 |date=August 2019 |pmid=31176801 |pmc=7110869 |doi=10.1016/j.pupt.2019.101812 |url=}}</ref>
*[[Bronchiectasis]]<ref name="pmid31176801">{{cite journal |vauthors=Mac Aogáin M, Chotirmall SH |title=Bronchiectasis and cough: An old relationship in need of renewed attention |journal=Pulm Pharmacol Ther |volume=57 |issue= |pages=101812 |date=August 2019 |pmid=31176801 |pmc=7110869 |doi=10.1016/j.pupt.2019.101812 |url=}}</ref>
*[[Laryngopharyngeal reflux disease|Laryngopharyngeal reflux]]
*[[Laryngopharyngeal reflux disease|Laryngopharyngeal reflux]]<ref name="pmid30364386">{{cite journal |vauthors=Patel DA, Blanco M, Vaezi MF |title=Laryngopharyngeal Reflux and Functional Laryngeal Disorder: Perspective and Common Practice of the General Gastroenterologist |journal=Gastroenterol Hepatol (N Y) |volume=14 |issue=9 |pages=512–520 |date=September 2018 |pmid=30364386 |pmc=6194652 |doi= |url=}}</ref>
*[[Respiratory tract infection]]
*[[Respiratory tract infection]]<ref name="pmid25383204">{{cite journal |vauthors=Dicpinigaitis PV |title=Effect of viral upper respiratory tract infection on cough reflex sensitivity |journal=J Thorac Dis |volume=6 |issue=Suppl 7 |pages=S708–11 |date=October 2014 |pmid=25383204 |pmc=4222932 |doi=10.3978/j.issn.2072-1439.2013.12.02 |url=}}</ref>
*[[Lung cancer]]<ref name="HarleMolassiotis2020">{{cite journal|last1=Harle|first1=Amélie|last2=Molassiotis|first2=Alex|last3=Buffin|first3=Oliver|last4=Burnham|first4=Jack|last5=Smith|first5=Jaclyn|last6=Yorke|first6=Janelle|last7=Blackhall|first7=Fiona H.|title=A cross sectional study to determine the prevalence of cough and its impact in patients with lung cancer: a patient unmet need|journal=BMC Cancer|volume=20|issue=1|year=2020|issn=1471-2407|doi=10.1186/s12885-019-6451-1}}</ref>
*[[Lung cancer]]<ref name="HarleMolassiotis2020">{{cite journal|last1=Harle|first1=Amélie|last2=Molassiotis|first2=Alex|last3=Buffin|first3=Oliver|last4=Burnham|first4=Jack|last5=Smith|first5=Jaclyn|last6=Yorke|first6=Janelle|last7=Blackhall|first7=Fiona H.|title=A cross sectional study to determine the prevalence of cough and its impact in patients with lung cancer: a patient unmet need|journal=BMC Cancer|volume=20|issue=1|year=2020|issn=1471-2407|doi=10.1186/s12885-019-6451-1}}</ref>
 
*Non-[[asthmatic]] [[eosinophilic]] [[bronchitis]]<ref name="pmid29404185">{{cite journal |vauthors=Yıldız T, Dülger S |title=Non-astmatic Eosinophilic Bronchitis |journal=Turk Thorac J |volume=19 |issue=1 |pages=41–45 |date=January 2018 |pmid=29404185 |pmc=5783052 |doi=10.5152/TurkThoracJ.2017.17017 |url=}}</ref>
* Non-[[asthmatic]] [[eosinophilic]] [[bronchitis]]
*Non-[[acid reflux disease]]<ref name="QiuXu2015">{{cite journal|last1=Qiu|first1=Zhongmin|last2=Xu|first2=Xianghuai|last3=Yu|first3=Li|last4=Chen|first4=Qiang|last5=Lv|first5=Hanjing|title=Diagnosis and treatment of patients with nonacid gastroesophageal reflux-induced chronic cough|journal=Journal of Research in Medical Sciences|volume=20|issue=9|year=2015|pages=885|issn=1735-1995|doi=10.4103/1735-1995.170625}}</ref>
*[[Non-acid reflux disease]]<ref name="QiuXu2015">{{cite journal|last1=Qiu|first1=Zhongmin|last2=Xu|first2=Xianghuai|last3=Yu|first3=Li|last4=Chen|first4=Qiang|last5=Lv|first5=Hanjing|title=Diagnosis and treatment of patients with nonacid gastroesophageal reflux-induced chronic cough|journal=Journal of Research in Medical Sciences|volume=20|issue=9|year=2015|pages=885|issn=1735-1995|doi=10.4103/1735-1995.170625}}</ref>
*[[Swallowing]] disorder<ref name="pmid25991980">{{cite journal |vauthors=Drozdz DR, Costa CC, Jesus PR, Trindade MS, Weiss G, Neto AB, da Silva AM, Mancopes R |title=Pharyngeal swallowing phase and chronic cough |journal=Int Arch Otorhinolaryngol |volume=16 |issue=4 |pages=502–8 |date=October 2012 |pmid=25991980 |pmc=4399588 |doi=10.7162/S1809-97772012000400012 |url=}}</ref>
*[[Swallowing]] disorder
*[[Congestive heart failure]]<ref name="FerasinLinney2019">{{cite journal|last1=Ferasin|first1=L.|last2=Linney|first2=C.|title=Coughing in dogs: what is the evidence for and against a cardiac cough?|journal=Journal of Small Animal Practice|volume=60|issue=3|year=2019|pages=139–145|issn=00224510|doi=10.1111/jsap.12976}}</ref>
*[[Congestive heart failure]]
* Habit [[cough]]<ref name="WeinbergerLockshin2017">{{cite journal|last1=Weinberger|first1=Miles|last2=Lockshin|first2=Boris|title=When is cough functional, and how should it be treated?|journal=Breathe|volume=13|issue=1|year=2017|pages=22–30|issn=1810-6838|doi=10.1183/20734735.015216}}</ref>
* Habitual [[cough]].


==Diagnosis==
==Diagnosis==
[[Acute cough]] is considered cough that lasts less than three weeks. Shown below is an algorithm summarizing the evaluation of acute [[cough]].<ref name="pmid29080708">{{cite journal| author=Irwin RS, French CL, Chang AB, Altman KW, CHEST Expert Cough Panel*| title=Classification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report. | journal=Chest | year= 2018 | volume= 153 | issue= 1 | pages= 196-209 | pmid=29080708 | doi=10.1016/j.chest.2017.10.016 | pmc=6689094 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29080708  }} </ref><ref name="BoujaoudePratter2009">{{cite journal|last1=Boujaoude|first1=Ziad C.|last2=Pratter|first2=Melvin R.|title=Clinical Approach to Acute Cough|journal=Lung|volume=188|issue=S1|year=2009|pages=41–46|issn=0341-2040|doi=10.1007/s00408-009-9170-6}}</ref><ref name="pmid27029594">{{cite journal |vauthors=Kilgore PE, Salim AM, Zervos MJ, Schmitt HJ |title=Pertussis: Microbiology, Disease, Treatment, and Prevention |journal=Clin Microbiol Rev |volume=29 |issue=3 |pages=449–86 |date=July 2016 |pmid=27029594 |pmc=4861987 |doi=10.1128/CMR.00083-15 |url=}}</ref>
Shown below is an algorithm summarizing the evaluation of acute, subacute, chronic [[cough]].<ref name="pmid29080708">{{cite journal| author=Irwin RS, French CL, Chang AB, Altman KW, CHEST Expert Cough Panel*| title=Classification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report. | journal=Chest | year= 2018 | volume= 153 | issue= 1 | pages= 196-209 | pmid=29080708 | doi=10.1016/j.chest.2017.10.016 | pmc=6689094 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29080708  }} </ref><ref name="BoujaoudePratter2009">{{cite journal|last1=Boujaoude|first1=Ziad C.|last2=Pratter|first2=Melvin R.|title=Clinical Approach to Acute Cough|journal=Lung|volume=188|issue=S1|year=2009|pages=41–46|issn=0341-2040|doi=10.1007/s00408-009-9170-6}}</ref><ref name="pmid27029594">{{cite journal |vauthors=Kilgore PE, Salim AM, Zervos MJ, Schmitt HJ |title=Pertussis: Microbiology, Disease, Treatment, and Prevention |journal=Clin Microbiol Rev |volume=29 |issue=3 |pages=449–86 |date=July 2016 |pmid=27029594 |pmc=4861987 |doi=10.1128/CMR.00083-15 |url=}}</ref><ref name="pmid32026427">{{cite journal |vauthors=Kaplan AG |title=Chronic Cough in Adults: Make the Diagnosis and Make a Difference |journal=Pulm Ther |volume=5 |issue=1 |pages=11–21 |date=June 2019 |pmid=32026427 |pmc=6966942 |doi=10.1007/s41030-019-0089-7 |url=}}</ref>




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*[[Subacute cough]] is considered 3 to 8 weeks. Shown below is an algorithm describing the evaluation of subacute [[cough]] in adults according to the [[American College of Chest Physicians]] guidelines.
.


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environmental and
environmental and
occupational factors,
occupational factors,
travel exposures=[[History]] and [[Physical Exam]], Ask about red flags,
travel exposures=[[History]] and [[Physical Exam]], Ask about red flags ''( [[hemoptysis]], [[smoking ]], [[dyspnea]], [[hoarseness]], abnormal [[CXR]] findings)''
[[environmental]] and
[[environmental]] and
[[occupational]] factors,
[[occupational]] factors,
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{{familytree | | | | | | | | | | | |!| | |)|-| COPD | | | |!| | | |!| | | |!| | | |!| | | |!| |COPD=[[COPD]]}}
{{familytree | | | | | | | | | | | |!| | |)|-| COPD | | | |!| | | |!| | | |!| | | |!| | | |!| |COPD=[[COPD]]}}
{{familytree | | | | | | | | | | | |!| | |!| | | | | | | UACS | | Asthma | | Bronchitis | | GERD | | Bronchiectasis|UACS=[[Upper airway]] [[cough]] syndrome|Asthma=[[Asthma]]|Bronchitis=[[Bronchitis]]|GERD=[[Gastroesophageal reflux disease]]|Bronchiectasis=[[Bronchiectasis]]}}
{{familytree | | | | | | | | | | | |!| | |!| | | | | | | UACS | | Asthma | | Bronchitis | | GERD | | Bronchiectasis|UACS=[[Upper airway]] [[cough]] syndrome|Asthma=[[Asthma]]|Bronchitis=[[Bronchitis]]|GERD=[[Gastroesophageal reflux disease]]|Bronchiectasis=[[Bronchiectasis]]}}
{{familytree | | | | | | | | | | |     |-|+|-| Postinfectious | | | | | | | | | | | |!| | | |Postinfectious=[[Postinfectious]]}}
{{familytree | | | | | | | | | | | |-|+|-| Postinfectious | | | | | | | | | | | |!| | | |Postinfectious=[[Postinfectious]]|k=[[ Condition]]}}
{{familytree | | | | | | | | | | | | | | |!| | | | | | | | | | | | |,|-|-|^|-|-|.| | | |}}  
{{familytree | | | | | | | | | | | | | | |!| | | | | | | | | | | | |,|-|-|^|-|-|.| | | |}}  
{{familytree | | | | | | | | | | | | | | |`|-| TB| | | | | | | |  NAEB | | | | AECB
{{familytree | | | | | | | | | | | | | | |`|-| TB| | | | | | | |  NAEB | | | | AECB
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<span style="font-size:85%">'''Abbreviations:'''
<span style="font-size:85%">'''Abbreviations:'''
'''TB:''' [[Tuberculosis]];
'''[[TB]]:''' [[Tuberculosis]];
'''NAEB:''' [[Nonasthmatic eosinophilic bronchitis;]];
'''[[COPD]]:''' [[Chronic obstructive pulmonary disease]];
'''AECB:''' [[ Acute exacerbation of chronic bronchitis]];
'''[[GERD]]:'''[[Gastroesophageal reflux disease]]
'''COPD''' [[Chronic obstructive pulmonary disease]];
'''GERD'''[[gastroesophageal reflux disease]];
'''UACS'''[[Upper airway cough syndrome]].


</span>
</span>
<br>
<br>
*Not postinfectious: Work up same as chronic cough


*[[Chronic cough]] is defined as cough that lasts more than 8 weeks. Shown below is an algorithm describing the evaluation of chronic [[cough]] in adults according to the [[American College of Chest Physicians]] guidelines.




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{{familytree | | |!| | | |!| | | | | | |!| | |!| | | | | }}
{{familytree | | |!| | | |!| | | | | | |!| | |!| | | | | }}
{{familytree | | Follow up 4-6 weeks if inadequate response| | Initial treatments for each condition| | | | | Further investigation if No response to treatment | |Consider four most common causes of cough if No response at 4-6 weeks follow up |Follow up 4-6 weeks if inadequate response=[[Follow up]] 4-6 weeks if inadequate response|Further investigation if No response to treatment=Further investigation if No response to [[treatment]]|Initial treatments for each condition=Initial [[treatments]] for each [[condition]]|Follow up 4-6 weeks if inadequate response to optimal treatment=Follow up 4-6 weeks if inadequate response to optimal [[treatment]]|Consider four most common causes of cough if No response at 4-6 weeks follow up=Consider four most common causes of [[cough]] if No response at 4-6 weeks [[follow up]]}}
{{familytree | | Follow up 4-6 weeks if inadequate response| | Initial treatments for each condition| | | | | Further investigation if No response to treatment | |Consider four most common causes of cough if No response at 4-6 weeks follow up |Follow up 4-6 weeks if inadequate response=[[Follow up]] 4-6 weeks if inadequate response|Further investigation if No response to treatment=Further investigation if No response to [[treatment]]|Initial treatments for each condition=Initial [[treatments]] for each [[condition]]|Follow up 4-6 weeks if inadequate response to optimal treatment=Follow up 4-6 weeks if inadequate response to optimal [[treatment]]|Consider four most common causes of cough if No response at 4-6 weeks follow up=Consider four most common causes of [[cough]] if No response at 4-6 weeks [[follow up]]}}
{{familytree | | | | | | |!| | | | | | | | | | | | | }}
{{familytree | | | | | | |!| | | | | | |!| | | | | }}
{{familytree | | | | | | Follow up 4-6 weeks if inadequate response to optimal treatment | | | | | | | | | | |Follow up 4-6 weeks if inadequate response to optimal treatment=[[Follow up]] 4-6 weeks if inadequate response to optimal [[treatment]]}}
{{familytree | | | | | | Follow up 4-6 weeks if inadequate response to optimal treatment | | | | C1 | | | |Follow up 4-6 weeks if inadequate response to optimal treatment=[[Follow up]] 4-6 weeks if inadequate response to optimal [[treatment]]| C1=<div style="float: left; text-align: left; height: 20em; width: 17em; padding:1em;"> '''The investigation:'''<br>
{{familytree | | | | | | | | | | | | | | | | | | | | }}
----
❑  24h [[esophageal]] [[pH]] monitoring<br> ❑ [[Endoscopic]], [[videofluoroscopic]] [[swallow]] evaluation  <br> ❑  [[Barium esophagram]] <br> ❑ [[Sinus Imaging]]  <br> ❑ [[HRCT]] <br>❑[[Bronchoscopy]]<br>❑ [[ECG]],[[ Holter]] Monitoring, [[Echocardiography]] <br>❑[[Environmental]] / [[Occupational]] Assessment<br></div>}}
{{familytree | | | | | | | | | | | | | | | | | | | }}
{{familytree/end}}
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*Consider the following further investigations if no response to [[treatment]]:
{{familytree/end}}
:* 24h [[esophageal]] [[pH]] / [[Impedance monitoring]]
 
:* [[Endoscopic]] and/or videofluoroscopic swallow evaluation
<span style="font-size:85%">'''Abbreviations:'''
:* [[Barium esophagram]] / Modified [[barium swallow]]
'''[[CXR]]:''' [[Chest-X-ray]];
:* [[Sinus Imaging]], [[HRCT]]
'''[[ACEI]]:''' [[Angiotensin converting enzyme inhibitor]];
:* [[Bronchoscopy]]
'''[[GERD]]:''' [[Gastroesophageal reflux disease]];
:* [[Cardiac]] Work-up ([[ECG]],[[ Holter]] Monitoring, [[Echocardiography]])
'''[[HRCT]] scan:'''[[High-resolution computed tomography]].
:* [[Environmental]] / [[Occupational]] Assessment
 
:* Consider uncommon causes
</span>
<br>


==Treatment==
==Treatment==
Shown below is an algorithm summarizing the treatment of [[Cough]].<ref name="BoujaoudePratter2009">{{cite journal|last1=Boujaoude|first1=Ziad C.|last2=Pratter|first2=Melvin R.|title=Clinical Approach to Acute Cough|journal=Lung|volume=188|issue=S1|year=2009|pages=41–46|issn=0341-2040|doi=10.1007/s00408-009-9170-6}}</ref>
Shown below is an algorithm summarizing the treatment of [[Cough]].<ref name="BoujaoudePratter2009">{{cite journal|last1=Boujaoude|first1=Ziad C.|last2=Pratter|first2=Melvin R.|title=Clinical Approach to Acute Cough|journal=Lung|volume=188|issue=S1|year=2009|pages=41–46|issn=0341-2040|doi=10.1007/s00408-009-9170-6}}</ref><ref name="YildizDulger2018">{{cite journal|last1=Yildiz|first1=Tekin|last2=Dulger|first2=Seyhan|title=Non-astmatic Eosinophilic Bronchitis|journal=Turkish Thoracic Journal|volume=19|issue=1|year=2018|pages=41–45|issn=21492530|doi=10.5152/TurkThoracJ.2017.17017}}</ref><ref name="pmid31478634">{{cite journal |vauthors=DeGeorge KC, Ring DJ, Dalrymple SN |title=Treatment of the Common Cold |journal=Am Fam Physician |volume=100 |issue=5 |pages=281–289 |date=September 2019 |pmid=31478634 |doi= |url=}}</ref><ref name="pmid26394802">{{cite journal |vauthors=Scanlon KM, Skerry C, Carbonetti NH |title=Novel therapies for the treatment of pertussis disease |journal=Pathog Dis |volume=73 |issue=8 |pages=ftv074 |date=November 2015 |pmid=26394802 |pmc=4626598 |doi=10.1093/femspd/ftv074 |url=}}</ref><ref name="pmid30201828">{{cite journal |vauthors=Speich B, Thomer A, Aghlmandi S, Ewald H, Zeller A, Hemkens LG |title=Treatments for subacute cough in primary care: systematic review and meta-analyses of randomised clinical trials |journal=Br J Gen Pract |volume=68 |issue=675 |pages=e694–e702 |date=October 2018 |pmid=30201828 |pmc=6145999 |doi=10.3399/bjgp18X698885 |url=}}</ref><ref name="Morice2004">{{cite journal|last1=Morice|first1=A.H.|title=The diagnosis and management of chronic cough|journal=European Respiratory Journal|volume=24|issue=3|year=2004|pages=481–492|issn=0903-1936|doi=10.1183/09031936.04.00027804}}</ref>
 
 




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{{Family tree | |,|-|-|^|-|-|.| | }}
{{Family tree | |,|-|-|^|-|-|.| | }}
{{Family tree | C01 | | | | C02 |C01= ❑''Determine if the cause of the [[cough]] is one of the [[life-threatening]] [[conditions]]'': <br> ❑[[Pneumonia]] <br> ❑Severe exacerbation of [[asthma]] or [[COPD]]<br> ❑ [[Pulmonary embolism]] <br> ❑[[Heart failure]]<br> ❑ Other serious condittons
{{Family tree | C01 | | | | C02 |C01= ❑''Determine if the cause of the [[cough]] is one of the [[life-threatening]] [[conditions]]'': <br> ❑[[Pneumonia]] <br> ❑Severe exacerbation of [[asthma]] or [[COPD]]<br> ❑ [[Pulmonary embolism]] <br> ❑[[Heart failure]]<br> ❑ Other serious condittons
| C02= ❑''[[Cough]] due to the [[common cold]]'':<br>❑ First-generation [[antihistamine]] plus a [[decongestant]]<br> ❑ [[Naproxen]] ([[Naprosyn]]) favorably affects [[cough]] <br> ❑ Newer-generation [[nonsedating]] [[antihistamines]] are not effective  <br> </div>}}
| C02= ❑''[[Cough]] due to the [[common cold]]'':<br>❑ First-generation [[antihistamine]] plus a [[decongestant]]<br> ❑[[Ipratropium]] <br> ❑ Newer-generation [[nonsedating]] [[antihistamines]] are not effective  <br> </div>}}
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<br>
<br>
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<br>
<br>
<br>
If a complete workup fails to find a cause for the cough, the remaining diagnosis is an unexplained cough. and referral to cough specialist should be considered


==Do's==
==Do's==
* Always first determine if the cause of the [[cough]] is one of the life-threatening [[conditions]] especially in the management of acute [[cough such]] as [[pulmonary embolism]] or [[obstructive airway disease]].
* Always first determine if the cause of the [[cough]] is one of the life-threatening [[conditions]] especially during management of acute [[cough ]] such as [[pulmonary embolism]] or [[obstructive airway disease]].
* Always evaluate [[environmental]] factors such as [[air pollution]] and occupational exposure for management of chronic [[cough]].<ref name="JoSong2019">{{cite journal|last1=Jo|first1=Eun-Jung|last2=Song|first2=Woo-Jung|title=Environmental triggers for chronic cough|journal=Asia Pacific Allergy|volume=9|issue=2|year=2019|issn=2233-8276|doi=10.5415/apallergy.2019.9.e16}}</ref>
* Always evaluate [[environmental]] factors such as [[air pollution]] and occupational exposure for management of chronic [[cough]].<ref name="JoSong2019">{{cite journal|last1=Jo|first1=Eun-Jung|last2=Song|first2=Woo-Jung|title=Environmental triggers for chronic cough|journal=Asia Pacific Allergy|volume=9|issue=2|year=2019|issn=2233-8276|doi=10.5415/apallergy.2019.9.e16}}</ref>
* [[Naproxen]] ([[Naprosyn]]) favorably affects the acute [[cough]] due to [[common cold]].
*[[Leukotriene inhibitor]] is prefered  to treat [[asthma]] induced chronic [[cough]] before  begining of oral [[corticosteroid]] agents for prevention of  the side effects of [[cotricosteroid]].
*[[Leukotriene inhibitor]] is prefered  to treat [[asthma]] induced chronic [[cough]] before  begining of oral [[corticosteroid]] agents for prevention of  the side effects of [[cotricosteroid]].
* Three common causes of chronic [[cough]]  include  [[upper aiway]] [[cough]] syndrome, [[asthma]], and [[gastroesophageal reflux disease]].<ref name="pmid22010767">{{cite journal |vauthors=Benich JJ, Carek PJ |title=Evaluation of the patient with chronic cough |journal=Am Fam Physician |volume=84 |issue=8 |pages=887–92 |date=October 2011 |pmid=22010767 |doi= |url=}}</ref><ref name="pmid8624180">{{cite journal |vauthors=Mello CJ, Irwin RS, Curley FJ |title=Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause |journal=Arch Intern Med |volume=156 |issue=9 |pages=997–1003 |date=May 1996 |pmid=8624180 |doi= |url=}}</ref>
* Three common causes of chronic [[cough]]  include  [[upper aiway]] [[cough]] syndrome, [[asthma]], and [[gastroesophageal reflux disease]].<ref name="pmid22010767">{{cite journal |vauthors=Benich JJ, Carek PJ |title=Evaluation of the patient with chronic cough |journal=Am Fam Physician |volume=84 |issue=8 |pages=887–92 |date=October 2011 |pmid=22010767 |doi= |url=}}</ref><ref name="pmid8624180">{{cite journal |vauthors=Mello CJ, Irwin RS, Curley FJ |title=Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause |journal=Arch Intern Med |volume=156 |issue=9 |pages=997–1003 |date=May 1996 |pmid=8624180 |doi= |url=}}</ref>
Line 248: Line 243:
==Don'ts==
==Don'ts==


* Do not continue [[ACE inhibitors]] if [[cough]] was associated with the begining of [[ACEI]].<ref name="McEwanChoudry1989">{{cite journal|last1=McEwan|first1=J. R.|last2=Choudry|first2=N.|last3=Street|first3=R.|last4=Fuller|first4=R. W.|title=Change in cough reflex after treatment with enalapril and ramipril.|journal=BMJ|volume=299|issue=6690|year=1989|pages=13–16|issn=0959-8138|doi=10.1136/bmj.299.6690.13}}</ref>
* Do not continue [[ACE inhibitors]] if [[cough]] is associated with the begining of [[ACEI]].<ref name="McEwanChoudry1989">{{cite journal|last1=McEwan|first1=J. R.|last2=Choudry|first2=N.|last3=Street|first3=R.|last4=Fuller|first4=R. W.|title=Change in cough reflex after treatment with enalapril and ramipril.|journal=BMJ|volume=299|issue=6690|year=1989|pages=13–16|issn=0959-8138|doi=10.1136/bmj.299.6690.13}}</ref>


* Do not miss the following red flags during an assessment of [[cough]]:<ref name="pmid32026427">{{cite journal |vauthors=Kaplan AG |title=Chronic Cough in Adults: Make the Diagnosis and Make a Difference |journal=Pulm Ther |volume=5 |issue=1 |pages=11–21 |date=June 2019 |pmid=32026427 |pmc=6966942 |doi=10.1007/s41030-019-0089-7 |url=}}</ref>
* Do not miss the following red flags during an assessment of [[cough]]:<ref name="pmid32026427">{{cite journal |vauthors=Kaplan AG |title=Chronic Cough in Adults: Make the Diagnosis and Make a Difference |journal=Pulm Ther |volume=5 |issue=1 |pages=11–21 |date=June 2019 |pmid=32026427 |pmc=6966942 |doi=10.1007/s41030-019-0089-7 |url=}}</ref>

Latest revision as of 09:20, 19 March 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Haddadi, M.D.[2] Sara Zand, M.D.[3]

Cough
Resident Survival Guide
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

Cough is a defense mechanism for preventation of airway irritation or aspiration by cleaning excessive secretion or foreign body from the airway and also it may spread infection. Cough is the symptom of involving organs such as upper airway tract, lung, heart, or gastrointestinal tract. Dependent on the duration of cough, it can be categorized to three groups including acute, subacute, chronic. Acute cough is the most common causes of seeking medical attention every year. Chronic cough may affect the quality of life and also may increase mortality based on the underlying disorder. Assessment of the life threatening causes of cough such as obstructive airway disease or pulmonary embolism is of important.

Causes

Common Causes

Diagnosis

Shown below is an algorithm summarizing the evaluation of acute, subacute, chronic cough.[15][16][17][18]


 
 
 
 
 
 
 
 
Acute Cough ≤ 3 weeks duration
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
History and physical

examination, ask about environmental and occupational factors and travel exposures

± investigations
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Life-threatening diagnosis
 
 
 
 
 
 
 
 
 
 
 
Non-life-threatening diagnosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pneumonia, severe

exacerbation of asthma or COPD, pulmonary embolism, heart failure, other serious

disease
 
 
 
 
 
Infections
 
 
 
 
 
 
 
 
 
Exacerbation of pre-existing condition
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lower respiratory tract infection
 
 
Upper respiratory tract infection
 
 
 
Asthma
 
Bronchiectasis
 
Upper airway cough syndrome
 
COPD
 
Evaluate and treat first
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute Bronchitis
 
 
 
Pertussis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider tuberculosis (TB) in

endemic areas

or high risk
 
 
 
 
 
 
 
 
 
 
 
 

.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Subacute Cough ,(3-8 weeks duration)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
History and Physical Exam, Ask about red flags ( hemoptysis, smoking , dyspnea, hoarseness, abnormal CXR findings)

environmental and occupational factors,

travel exposures
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Postinfectious or life-threatening diagnosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
New onset or exacerbation of pre-existing condition
 
 
 
 
Not postinfectious
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pneumonia, severe exacerbation of asthma or COPD,pulmonary embolism, heart failure, other serious disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pertussis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
COPD
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Upper airway cough syndrome
 
Asthma
 
Bronchitis
 
Gastroesophageal reflux disease
 
Bronchiectasis
 
 
 
 
 
 
 
 
 
 
Condition
 
 
 
 
Postinfectious
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Tuberculosis
 
 
 
 
 
 
 
Non-asthmatic eosinophilic bronchitis
 
 
 
Acute exacerbation of chronic bronchitis/COPD
 
 
 
 
 

Abbreviations: TB: Tuberculosis; COPD: Chronic obstructive pulmonary disease; GERD:Gastroesophageal reflux disease



 
 
 
 
 
 
 
 
Chronic Cough> 8 weeks duration
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
History, Physical exam and CXR
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Life-threatening condition
 
 
 
 
Consider four most common causes: 1) Upper Airway Cough Syndrome secondary to rhinosinus diseases, 2) Asthma, 3) Non-asthmatic Eosinophilic Bronchitis,4) Gastroesophageal Reflux Disease (GERD)
 
 
 
 
Smoking, ACEI
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treat based on the cause
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Discontinue for at least four weeks
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Follow up 4-6 weeks if inadequate response
 
Initial treatments for each condition
 
 
 
 
Further investigation if No response to treatment
 
Consider four most common causes of cough if No response at 4-6 weeks follow up
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Follow up 4-6 weeks if inadequate response to optimal treatment
 
 
 
The investigation:

❑ 24h esophageal pH monitoring
Endoscopic, videofluoroscopic swallow evaluation
Barium esophagram
Sinus Imaging
HRCT
Bronchoscopy
ECG,Holter Monitoring, Echocardiography
Environmental / Occupational Assessment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Abbreviations: CXR: Chest-X-ray; ACEI: Angiotensin converting enzyme inhibitor; GERD: Gastroesophageal reflux disease; HRCT scan:High-resolution computed tomography.


Treatment

Shown below is an algorithm summarizing the treatment of Cough.[16][19][20][21][22][23]



 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute Cough
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Determine if the cause of the cough is one of the life-threatening conditions:
Pneumonia
❑Severe exacerbation of asthma or COPD
Pulmonary embolism
Heart failure
❑ Other serious condittons
 
 
 
Cough due to the common cold:
❑ First-generation antihistamine plus a decongestant
Ipratropium
❑ Newer-generation nonsedating antihistamines are not effective





 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Subacute Cough
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
confirmed whooping cough by culture positive nasopharyngeal swab:
macrolide antibiotics plus isolation for 5 days
 
 
 
Cough not caused by bordetella pertussis:
Inhaled ipratropium (Atrovent)
❑ If cough persists: inhaled corticosteroids
❑ Severe cough:30 to 40 mg of prednisone per day for a brief period)
❑ When other treatments fail: codeine or dextromethorphan (Delsym)




 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chronic Cough
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
UPPER AIRWAY COUGH SYNDROME–INDUCED CHRONIC COUGH
First-generation antihistamine/decongestant
❑Partial or complete resolution of cough after one to two weeks shows upper airway cough syndrome as the cause
❑ Persistent symptoms: begin a topical nasal steroid
Symptoms still persist: sinus imaging for sinusitis
 
 
 
ASTHMA-INDUCED CHRONIC COUGH
❑ Inhaled corticosteroids and beta agonists
❑ No response or cannot take inhaled medication:consider oral corticosteroids for 5-10 days
❑ Consider adding a leukotriene inhibitor before an oral corticosteroid
 
 
 
 
NON-ASTHMATIC EOSINOPHILIC BRONCHITIS-INDUCED CHRONIC COUGH
❑ Inhaled corticosteroids for 4 weeks
 
 
GERD-INDUCED CHRONIC COUGH
❑ Empirically treated for GERD if there is not response to therapy
❑ Anti-reflux diet, lifestyle modification, proton pump inhibitor
❑ Adding prokinetic therapy if there is NO response to treatment
 
 
 
 
 



Do's

Don'ts

References

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  2. Kim V, Criner GJ (February 2013). "Chronic bronchitis and chronic obstructive pulmonary disease". Am J Respir Crit Care Med. 187 (3): 228–37. doi:10.1164/rccm.201210-1843CI. PMC 4951627. PMID 23204254.
  3. Sylvester DC, Karkos PD, Vaughan C, Johnston J, Dwivedi RC, Atkinson H, Kortequee S (2012). "Chronic cough, reflux, postnasal drip syndrome, and the otolaryngologist". Int J Otolaryngol. 2012: 564852. doi:10.1155/2012/564852. PMC 3332192. PMID 22577385.
  4. Akelma, Ahmet Zulfikar; Cizmeci, Mehmet Nevzat; Kanburoglu, Mehmet Kenan; Mete, Emin (2013). "An Overlooked Cause of Cough in Children: Foreign Body Aspiration". The Journal of Pediatrics. 163 (1): 292–293. doi:10.1016/j.jpeds.2012.12.089. ISSN 0022-3476.
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  6. Mac Aogáin M, Chotirmall SH (August 2019). "Bronchiectasis and cough: An old relationship in need of renewed attention". Pulm Pharmacol Ther. 57: 101812. doi:10.1016/j.pupt.2019.101812. PMC 7110869 Check |pmc= value (help). PMID 31176801.
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  9. Harle, Amélie; Molassiotis, Alex; Buffin, Oliver; Burnham, Jack; Smith, Jaclyn; Yorke, Janelle; Blackhall, Fiona H. (2020). "A cross sectional study to determine the prevalence of cough and its impact in patients with lung cancer: a patient unmet need". BMC Cancer. 20 (1). doi:10.1186/s12885-019-6451-1. ISSN 1471-2407.
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  15. Irwin RS, French CL, Chang AB, Altman KW, CHEST Expert Cough Panel* (2018). "Classification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report". Chest. 153 (1): 196–209. doi:10.1016/j.chest.2017.10.016. PMC 6689094 Check |pmc= value (help). PMID 29080708.
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  19. Yildiz, Tekin; Dulger, Seyhan (2018). "Non-astmatic Eosinophilic Bronchitis". Turkish Thoracic Journal. 19 (1): 41–45. doi:10.5152/TurkThoracJ.2017.17017. ISSN 2149-2530.
  20. DeGeorge KC, Ring DJ, Dalrymple SN (September 2019). "Treatment of the Common Cold". Am Fam Physician. 100 (5): 281–289. PMID 31478634.
  21. Scanlon KM, Skerry C, Carbonetti NH (November 2015). "Novel therapies for the treatment of pertussis disease". Pathog Dis. 73 (8): ftv074. doi:10.1093/femspd/ftv074. PMC 4626598. PMID 26394802.
  22. Speich B, Thomer A, Aghlmandi S, Ewald H, Zeller A, Hemkens LG (October 2018). "Treatments for subacute cough in primary care: systematic review and meta-analyses of randomised clinical trials". Br J Gen Pract. 68 (675): e694–e702. doi:10.3399/bjgp18X698885. PMC 6145999. PMID 30201828.
  23. Morice, A.H. (2004). "The diagnosis and management of chronic cough". European Respiratory Journal. 24 (3): 481–492. doi:10.1183/09031936.04.00027804. ISSN 0903-1936.
  24. Jo, Eun-Jung; Song, Woo-Jung (2019). "Environmental triggers for chronic cough". Asia Pacific Allergy. 9 (2). doi:10.5415/apallergy.2019.9.e16. ISSN 2233-8276.
  25. Benich JJ, Carek PJ (October 2011). "Evaluation of the patient with chronic cough". Am Fam Physician. 84 (8): 887–92. PMID 22010767.
  26. Mello CJ, Irwin RS, Curley FJ (May 1996). "Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause". Arch Intern Med. 156 (9): 997–1003. PMID 8624180.
  27. Rudolph, Colin D.; Mazur, Lynnette J.; Liptak, Gregory S.; Baker, Robert D.; Boyle, John T.; Colletti, Richard B.; Gerson, William T.; Werlin, Steven L. (2001). "Guidelines for Evaluation and Treatment of Gastroesophageal Reflux in Infants and Children". Journal of Pediatric Gastroenterology and Nutrition. 32: S1–S31. doi:10.1097/00005176-200100002-00001. ISSN 0277-2116.
  28. Pratter, Melvin R. (2006). "Chronic Upper Airway Cough Syndrome Secondary to Rhinosinus Diseases (Previously Referred to as Postnasal Drip Syndrome )". Chest. 129 (1): 63S–71S. doi:10.1378/chest.129.1_suppl.63S. ISSN 0012-3692.
  29. Turner, Richard D.; Bothamley, Graham H. (2015). "Cough and the Transmission of Tuberculosis". The Journal of Infectious Diseases. 211 (9): 1367–1372. doi:10.1093/infdis/jiu625. ISSN 0022-1899.
  30. MacIntyre, C Raina; Bourouiba, Lydia; Chughtai, Abrar Ahmad; de Silva, Charitha; Doolan, Con; Bahl, Prateek (2020). "Airborne or Droplet Precautions for Health Workers Treating Coronavirus Disease 2019?". The Journal of Infectious Diseases. doi:10.1093/infdis/jiaa189. ISSN 0022-1899.
  31. McEwan, J. R.; Choudry, N.; Street, R.; Fuller, R. W. (1989). "Change in cough reflex after treatment with enalapril and ramipril". BMJ. 299 (6690): 13–16. doi:10.1136/bmj.299.6690.13. ISSN 0959-8138.