Chronic cough: Stepwise application in primary care practice of the ACCP guidelines for diagnosis and management of cough.

PURPOSE: To illustrate decision points encountered when using evidence-based guidelines for diagnosis and management of chronic cough by means of a composite case study based on primary care practice.

DATA SOURCE: The American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines for Diagnosis and Management of Cough, and review of the scientific literature on cough and related topics.

CONCLUSIONS: The ACCP guidelines offer a systematic approach that uses trials of empirical therapies to diagnose and resolve the very common, often perplexing complaint of chronic cough. The major diagnoses reached are upper airway cough syndrome, cough-variant asthma, gastroesophageal reflux disease, and nonasthmatic eosinophilic bronchitis.

IMPLICATIONS FOR PRACTICE: Cough is the most common reason that patients seek an office visit. Many coughs resolve spontaneously, but coughs that persist significantly impair the quality of life. Use of the ACCP guidelines allows a stepwise empirical approach to the problem of unexplained chronic cough. This approach greatly increases the percentage of chronic coughs that are accurately diagnosed and effectively treated, and avoids unnecessary diagnostic testing.