April - June 2012: 
Volume 25, Issue 2

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Pneumon 2012, 25(2):164-175
The never-ending challenge of chronic cough in adults. A Review for the Clinician
SUMMARY. Despite progress in the understanding of the mechanisms and aetiology of cough, it remains an alarming and annoying symptom for both patients and physicians. Chronic cough lasting for more than 8 weeks is one of the main reasons for referral in primary or secondary health care and the first symptom of many pulmonary and extra-pulmonary conditions. Its aetiology usually includes environmental causes, including exposure to cigarette smoke and environmental pollution, and several disease entities, both respiratory and non-respiratory. The most common respiratory causes are chronic obstructive pulmonary disease (COPD), bronchiectasis, upper airway cough syndrome (UACS) due to a variety of rhinosinus diseases, asthma and non-asthmatic eosinophilic bronchitis. Non-respiratory causes of cough include the use of angiotensin-converting enzyme (ACE) inhibitor agents and gastro-oesophageal reflux disease. Chronic cough may be multi-factorial and only rarely is its cause not identified, leading to the diagnosis of idiopathic chronic cough. Chronic cough is a disturbing symptom that affects the health-related quality of life of the patients and presents a diagnostic and therapeutic challenge for the clinician. This review summarizes the current evidence on the aetiology and the diagnostic difficulties of chronic cough in adults, and provides an algorithmic approach, along with practical tips, for its management by the busy practicing clinician. Pneumon 2012, 25(2):164-175.