Cough is the most frequent reason for a GP visit and most acute episodes have obvious disease relation, for example viral illness, chronic obstructive airways disease, pneumonia. However, when cough is prolonged and the chest x-ray is normal, an underlying disease may not be obvious.

The term ‘Persistent Cough’ has been adopted internationally to describe this situation and refers to non-productive cough (cough without sputum) which has been present for eight weeks or more. This can be frustrating, disabling, and even socially isolating for sufferers because whereas the cough itself is very disturbing, it may also be associated with a range of other physical and psychosocial features – fatigue, disturbed sleep for both patient and partner, headache, chest and abdominal pain, stress incontinence in females, anxiety and depression and not infrequently, workplace disturbance.

The major group of conditions recognised to be associated with Persistent Cough include gastro-oesophageal reflux (which may or may not be associated with ‘heartburn’), unrecognised mild asthma (so-called ‘cough-variant asthma’), nasal and sinus disease (allergic or non-allergic rhinitis with post-nasal drip, chronic sinusitis) and an otherwise benign condition known as eosinophilic bronchitis.

The first priority is to rule out serious underlying disease and those mentioned above but it remains a fact that even after extensive investigation, many cases of Persistent Cough cannot be easily attributed to a specific cause and we now term this ‘Chronic Refractory Cough’. This may relate to an as yet poorly-characterised disturbance of cough receptors on nerve endings which are present not only in the lower airways but also in the larynx, pharynx, oesophagus, stomach and diaphragm.

Special experience is required to diagnose and manage these more difficult cases and may require expertise from a variety of disciplines including not only chest physicians but also ENT specialists, speech therapists and surgeons.  Such cases require careful assessment on an individual basis and should further tests be required, including diagnostic scans, upper gastrointestinal studies or blood tests, we can carry these out making the process seamless from start to finish. 

Treatment might include appropriate dietary and lifestyle measures and Speech and Language Therapy to learn vocal apparatus hydration and cough suppression techniques. Recent evidence has shown that not all patents require medication although several drugs can be very helpful where appropriate. It remains said that most cases require several appointments to establish a diagnosis and initiate appropriate treatment.