Acute cough (<3 weeks) is common, usually self-limiting, and due to a viral infection. Cough may persist for longer in more severe infection such as COVID-19 or community-acquired pneumonia. Chronic cough in adults (a cough lasting >8 weeks) is common in primary care (UK prevalence 5%),1 and is associated with impaired quality of life and significant healthcare costs.

Recent British Thoracic Society guidance on chronic cough in adults2 outlines a pragmatic and evidence-based approach (Figure 1). After the exclusion of common disease and aggravants, cough may be due to one or several observable ‘treatable traits’ (Figure 2).

Management of chronic cough in primary care. 2WW = 2-week wait. ACEI = angiotensin-converting enzyme inhibitor. AFB = acid-fast bacillus test. BEC = blood eosinophil count. COPD = chronic obstructive pulmonary disease CXR = chest X-ray. FBC = full blood count. FeNO = fractional exhaled nitric oxide. ICS = inhaled corticosteroids. ILD = interstitial lung disease. PPI = proton pump inhibitor. TB = tuberculosis. © British Thoracic Society. Used with permission.

Treatable traits in chronic cough. ACEI = angiotensin-converting enzyme inhibitor. © British Thoracic Society. Used with permission.

The history and examination should help identify common causes and aggravants, and red-flag symptoms requiring urgent referral (Figure 1).

Some symptoms may identify specific traits such as episodic wheeze …