A cough that persists for eight weeks or more is rarely trivial yet chronic cough remains one of the most underinvestigated and mismanaged conditions in respiratory medicine. Many patients are told their cough is stress-related, viral or simply idiopathic, without the structured assessment needed to identify the true underlying cause. Dr Sundeep Kaul provides a thorough, evidence-based approach to chronic cough, using advanced diagnostics to reach an accurate diagnosis and build a targeted management plan that goes beyond empirical treatment.
What Is Chronic Cough?
Chronic cough is defined as a cough lasting eight weeks or longer in adults. It can arise from a wide range of causes — including eosinophilic airway disease, laryngeal hypersensitivity, upper airway cough syndrome (post-nasal drip), gastro-oesophageal reflux, and less commonly, more serious underlying lung pathology. In many cases, multiple contributing factors are present simultaneously, which is why a systematic, specialist-led approach is essential to reaching the correct diagnosis. Left unaddressed, chronic cough significantly affects quality of life, sleep, social functioning and mental wellbeing.
Symptoms May Include
- Persistent dry or tickling cough
- Cough lasting more than eight weeks
- Throat irritation or scratching sensation
- Coughing triggered by talking, laughing or cold air
- Cough worsening at night or on lying down
- Hoarseness or voice changes
- Sensation of mucus at the back of the throat
- Waking from sleep due to coughing
Diagnostic Assessment
Your consultation may include:
- Detailed cough history and symptom timeline
- Clinical examination of the upper and lower airways
- Spirometry and full lung function testing
- FeNO (fractional exhaled nitric oxide) — to identify eosinophilic airway inflammation
- Assessment of potential reflux and post-nasal causes
- Chest X-ray or CT chest where indicated
- Review of current medications (e.g. ACE inhibitors, which are a common cough trigger)
- Allergy and sensitivity assessment where relevant
Treatment Approach
Treatment plans are personalised based on the identified underlying cause and may include:
- Inhaled corticosteroids for eosinophilic cough
- Anti-reflux therapy where GORD is contributing
- Nasal and throat treatments for upper airway causes
- Neuromodulatory therapy for laryngeal hypersensitivity
- Medication review and adjustment
- Speech and language therapy referral where appropriate
- Allergen avoidance strategies
- Structured follow-up to review response and adjust treatment
Why Early Assessment Matters
Untreated chronic cough can mask a serious underlying condition and significantly reduces quality of life over time. Early specialist assessment ensures the correct diagnosis is reached promptly — avoiding months of ineffective empirical treatment and unnecessary suffering.
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