Treatment of subacute and chronic cough in adults
- Steven E Weinberger, MD
Steven E Weinberger, MD
- Adjunct Professor of Medicine
- University of Pennsylvania School of Medicine
- Executive Vice President and CEO Emeritus
- American College of Physicians
- Ronald C Silvestri, MD
Ronald C Silvestri, MD
- Assistant Professor of Medicine
- Harvard Medical School
- Section Editors
- Peter J Barnes, DM, DSc, FRCP, FRS
Peter J Barnes, DM, DSc, FRCP, FRS
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Asthma
- Professor of Medicine
- National Heart and Lung Institute, Imperial College, London
- Talmadge E King, Jr, MD
Talmadge E King, Jr, MD
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Interstitial Lung Disease
- Dean, School of Medicine
- Vice Chancellor, Medical Affairs
- University of California San Francisco
Although an acute and self-limited cough often does not require therapy, prolonged cough can be a bothersome symptom that precipitates many outpatient visits to the clinician for treatment. Differing definitions for a chronic cough have been proposed that require symptoms for varying times from two weeks to three months [1,2]. Guidelines from the American College of Chest Physicians distinguish three categories of cough based upon duration :
●Acute cough, lasting less than three weeks
●Subacute cough, lasting between three and eight weeks
●Chronic cough, lasting more than eight weeks
The initial priorities for patients with cough lasting more than three weeks (subacute or chronic cough) are to identify a precipitant or etiology, and then to eliminate the precipitant or treat the underlying cause [3-6].
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- SPECIFIC TREATMENT
- Upper airway cough syndrome
- Cough variant asthma
- Nonasthmatic eosinophilic bronchitis
- Gastroesophageal reflux
- - Lifestyle modifications
- - Acid-suppression medication
- - Other therapies
- Following an upper respiratory tract infection
- Angiotensin converting enzyme inhibitors and receptor blockers
- NONSPECIFIC TREATMENT
- Centrally acting antitussive agents
- - Dextromethorphan
- - Codeine
- - Morphine
- - Gabapentin and pregabalin
- Peripherally acting antitussive agents
- Inhaled glucocorticoids
- Ipratropium bromide
- Macrolide antibiotics
- Non-pharmacologic interventions
- FUTURE DIRECTIONS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Specific therapy
- Nonspecific therapy