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Curtis J. Mello, MD; Richard S. Irwin, MD; Frederick J. Curley, MD

Arch Intern Med. 1996;156(9):997-1003.

Abstract
Background
It is not clear whether careful history taking with detailed questioning of the characteristics of cough is diagnostically useful.

Objective
To determine if the character, timing, or complications of chronic cough were helpful in determining its cause.

Methods
A prospective, descriptive study of consecutive, unselected, immunocompetent patients referred to our university outpatient clinic because of chronic cough. All patients were evaluated by a previously published and validated systematic diagnostic protocol, a self-administered questionnaire, and by observing the character of involuntary and voluntary coughs. The final diagnosis of the cause of cough required fulfillment of pre pretreatment criteria plus having cough disappear or substantially improve as a complaint with specific therapy.

Results
Eighty-eight patients met inclusion criteria and were fully evaluated. The mean±SD age was 53.1 ± 16 years (range, 15-83 years) and 24 were males and 64 were females with a mean±SD history of cough for 6.6±9.8 years (range, 1 month-44 years). The cause of chronic cough was established in 86 (98%) of 88 patients. Eighty-one (92%) of 88 had cough disappear as a complaint. Cough was as a result of a single cause in 39% and multiple causes in 59%. Gastroesophageal reflux disease, postnasal drip syndrome, and asthma were the 3 most common causes of chronic cough and accounted for 90% % of diagnoses. Gastroesophageal reflux disease, postnasal drip syndrome, and asthma were again found to be the 3 most common causes of chronic cough irrespective of patient estimated quantity of daily sputum production. These 3 conditions caused chronic cough in 99.4% of patients with the following characteristics: (1) nonsmoker; (2) not receiving an angiotensin-converting enzyme inhibitor drug; and (3) normal or nearly normal and stable chest radiograph. With respect to the spectrum and frequency of diagnoses and their interrelationships with the character, timing, and complications of cough, multiple stepwise linear regression analysis showed that none of the variability of the character, timing, or complications of cough could be explained by any specific diagnosis.

Conclusions
A carefully taken history with detailed questioning of the character, timing, and complications of chronic cough is not likely to be useful in diagnosing the cause of cough. The cause can be determined and successfully treated with specific therapy in the greatest majority of cases. Chronic cough is often caused by multiple, simultaneously contributing causes. Postnasal drip syndrome, asthma, and gastroesophageal reflux disease remain the 3 most common causes of chronic cough and there is a clinical profile that nearly always predicts their presence in immunocompetent patients.

(Arch Intern Med. 1996;156:997-1003)

Author Affiliations
From the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester.

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