Diagnosis and assessment of chronic cough in adults – a brief guide and clinical algorithm for primary care

This health professional fact sheet and clinical algorithm focusing on chronic cough in adults, developed by Lung Foundation Australia, provides an evidence-based guide to support the assessment, diagnosis and management of cough lasting longer than eight weeks. Chronic cough is not normal and may signal serious underlying health and chronic lung conditions. It can significantly affect quality of life, causing social isolation, laryngeal trauma, incontinence, and other complications. The resource outlines the potential causes of chronic cough, including diseases affecting the upper, middle and lower airways, systemic conditions such as reflux, smoking, ACE inhibitor use, and post-infectious inflammation. It emphasises that a thorough patient history and investigations including chest X-ray, and spirometry (before and after bronchodilator) should be completed in all adults presenting with chronic cough. Where red flags exist—such as haemoptysis, weight loss, or abnormal imaging—further investigation via CT scan and referral to a respiratory physician may be warranted.

The fact sheet includes a clinical algorithm for primary care providers and outlines when to refer patients to ENT, speech pathology, or gastroenterology based on the suspected underlying cause. It highlights asthma and eosinophilic bronchitis as common contributors and provides clear guidance on objective testing before initiating inhaled corticosteroid therapy. The document also presents treatment recommendations aligned with clinical guidelines for conditions like allergic rhinitis, laryngeal hypersensitivity, vocal cord dysfunction, GORD, chronic bronchitis, COPD, interstitial lung disease, and unexplained chronic cough.

By promoting early identification, appropriate testing, and targeted treatment or referral, this resource aims to improve outcomes and reduce the burden of chronic cough. It equips clinicians with tools to manage both common and complex cases, while discouraging ineffective therapies such as proton pump inhibitors in patients without reflux symptoms. This chronic cough fact sheet is a practical clinical guide for primary care practitioners and respiratory health specialsits and professionals across Australia.