An office approach to the diagnosis of chronic cough

Chronic cough is a common problem in patients who visit family physicians. The three most common causes of chronic cough in those who are referred to pulmonary specialists are postnasal drip, asthma and gastroesophageal reflu x. The initial treatment of patients with cough is often empiric and may in volve a trial of decongestants, bronchodilators or histamine H-2 antagonist s, as monotherapy or in combination. Ifa therapeutic trial is not successfu l, sequential diagnostic testing including chest radiograph, purified prote in derivative test for tuberculosis, computed tomography of the sinuses, me thacholine challenge test or barium swallow may be indicated By using a sta ndard protocol for diagnosis and treatment, 90 percent of patients with chr onic cough can be managed successfully in the family physician's office. Ho wever, in some cases it may take three to five months to determine a diagno sis and effective treatment. For the minority of patients in whom this diag nostic approach is unsuccessful, consultation with a pulmonary specialist i s appropriate.