Chronic cough: New insights into diagnostic challenges and treatment approaches

Chronic cough, defined as a persistent cough lasting over eight weeks, affects approximately 10% of the adult population and is a frequent cause for medical consultations. Despite its commonality, the diagnosis and management of chronic cough remain complex due to the vast array of potential underlying causes. Acute coughs are typically associated with respiratory infections, but chronic cough can arise from conditions such as asthma, chronic obstructive pulmonary disease (COPD), gastroesophageal reflux disease (GERD), or upper airway cough syndrome (UACS). More rarely, it may be linked to serious conditions like lung cancer, interstitial lung disease, or tuberculosis.

The updated 2021 German Clinical Practice Guidelines propose a structured approach to the diagnosis and treatment of chronic cough. This includes taking a detailed patient history, ruling out "red flag" symptoms such as hemoptysis, dyspnea, and significant weight loss, and conducting baseline diagnostic tests like chest x-rays and pulmonary function tests. If no specific cause is identified, empirical treatments for asthma, UACS, or GERD may be trialed.

For patients with unexplained or refractory chronic cough, non-pharmacological treatments such as speech therapy and physiotherapy have shown promising results. Pharmacological options, including gabapentin and low-dose morphine, are used off-label in some cases, with clinical trials supporting their efficacy in reducing cough symptoms. Despite advancements, a significant portion of chronic cough patients remains undiagnosed or undertreated, highlighting the need for further research into tailored treatments and diagnostic methods.