Chronic cough: Seeking the cause and the solution

In most nonsmokers, chronic cough is caused by postnasal drip syndrome (PNDS), asthma, or gastroesophageal reflux disease (GERD). A high index of suspicion is required, because each of these conditions may present with cough as the sole symptom. Because PNDS is the most common cause of chronic cough, it appears reasonable to initially give empiric PNDS therapy to patients in whom other causes are not evident. In many cases, the combination of a first-generation antihistamine and a decongestant may be most effective. In general, the therapeutic approach to cough-variant asthma is similar to that of the typical form of asthma. Many patients have symptomatic improvement after 1 week of therapy with inhaled bronchodilators. For persistent cough associated with asthma, inhaled corticosteroids should be added. Initial empiric therapy with a proton pump inhibitor may be appropriate for patients with GERD-induced cough.