How to Assess Cough in the Clinic

Chronic cough is a common reason for medical consultation, and effective assessment is essential for management. A routine clinical assessment should include history, examination, a chest radiograph and spirometry as a minimum. Further investigations should be guided by the presenting features, comorbidities, and previous investigation results and responses to treatment trials. These investigations, including oesophageal manometry, are often used to assess specific aetiologies. Assessments of cough severity and impact should also be used, and repeated over time, particularly in response to treatment trials. It is not uncommon to fail to identify the ultimate underlying cause of chronic cough. The desire of both the patient and the clinician to identify the aetiology will guide investigations to some extent, although it is important to avoid over-investigation beyond the current evidence base and guidelines.