From a Prospective Study of Chronic Cough

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Abstract
COUGH IS the most common complaint for which adults see a physician in the ambulatory setting in the United States.1 A great deal is known about this symptom. Cough is the result of stimulation of a reflex involving receptors inside and outside of the lower respiratory tract, afferent nerves, a central nervous system cough center, efferent nerves, and effector organs. The mechanism of a cough consists of an inspiratory phase, a compressive phase, and an expiratory phase. Cough can be divided into 3 categories: acute and transient, lasting less than 3 weeks and of minor consequence; acute and potentially life-threatening; and chronic, lasting 3 weeks or more. Acute and transient cough is most frequently due to the common cold. Using a protocol that evaluates the locations of the afferent limb of the cough reflex, the cause of chronic cough can be found between 88% and 100% of the time. Postnasal drip syndrome (PNDS), asthma, and gastroesophageal reflux disease (GERD) are the most common causes of chronic cough. Cough can be the sole presenting manifestation of asthma and GERD. Although chronic cough can be treated either specifically or nonspecifically, specific treatment is effective in most cases.

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