Chronic Cough, a New Disease, Not Just An Old Problem

Authors

  • Alan Kaplan, MD, CCFP(EM), CPC(HC) University of Toronto, Ontario, Canada

DOI:

https://doi.org/10.58931/cpct.2025.3139

Abstract

Chronic cough is defined as a cough persisting for longer than 8 weeks. Chronic cough is common, with an approximate prevalence of 10% of the global population. In Canada, recent estimates indicate that the prevalence of cough is 16% among adults aged 45-85 years. Chronic cough can interrupt work, sleep, and social interactions, making it very troubling for patients, with impacts on physical, social, and psychological health.

Cough is one of the leading causes of visits to primary care practitioners. The peak incidence for presentation to primary care is among individuals in the 50-60 years age group and it is twice as frequent in women.

Currently, most clinicians address cough as a symptom of other medical conditions, which leads to trials of treatments for diseases that may not be present. This approach can lead to unnecessary costs, frustration for both clinicians and patients, and potential harms from the therapies prescribed. Instead, a diagnostic work up needs to be performed to identify refractory chronic cough as a distinct disease entity, resulting from afferent neuronal hypersensitivity and central nervous system dysfunction. The secondary factors that aggravate chronic cough (smoking, asthma, gastro-esophageal reflux, among others) should be considered as treatable traits associated with the primary disease process rather than only the direct causes of the cough.

Author Biography

Alan Kaplan, MD, CCFP(EM), CPC(HC), University of Toronto, Ontario, Canada

Dr. Kaplan is a family physician based in Aurora, Ontario. He is the chairperson of the Family Physician Airways Group of Canada and the Vice President, Respiratory Effectiveness Group. Dr. Kaplan is also the regional primary care cancer lead, Central Region, Ontario. Dr. Kaplan is also a clinical lecturer at the University of Toronto in the Department of Family and Community Medicine, a member of the Medical Advisory Committee of the Pulmonary Hypertension Association of Canada and a member of the section of Allergy and Respiratory Therapeutics, Health Canada. Dr. Kaplan has authored 159 peer reviewed articles and 127 conference abstracts.

References

Irwin RS, French CL, Chang AB, Altman KW. Classification of cough as a symptom in adults and management algorithms: CHEST Guideline and Expert Panel Report. Chest. 2018;153(1):196-209. doi:10.1016/j.chest.2017.10.016 DOI: https://doi.org/10.1016/j.chest.2017.10.016

Song WJ, Chang YS, Faruqi S, Kim JY, Kang MG, Kim S, et al. The global epidemiology of chronic cough in adults: a systematic review and meta-analysis. Eur Respir J. 2015;45(5):1479-1481. doi:10.1183/09031936.00218714 DOI: https://doi.org/10.1183/09031936.00218714

Satia I, Mayhew AJ, Sohel N, Kurmi O, Killian KJ, O'Byrne PM, et al. Prevalence, incidence and characteristics of chronic cough among adults from the Canadian Longitudinal Study on Aging. ERJ Open Res. 2021;7(2). doi:10.1183/23120541.00160-2021 DOI: https://doi.org/10.1183/23120541.00160-2021

Oliveira A, Grave AS, Brooks D, Satia I. Impact of chronic cough on quality of life. Barcelona Respiratory Network. 2023. DOI: https://doi.org/10.23866/BRNRev:2023-M0090

Finley CR, Chan DS, Garrison S, Korownyk C, Kolber MR, Campbell S, et al. What are the most common conditions in primary care? Systematic review. Can Fam Physician. 2018;64(11):832-840.

Morice AH, Fontana GA, Belvisi MG, Birring SS, Chung KF, Dicpinigaitis PV, et al. ERS guidelines on the assessment of cough. Eur Respir J. 2007;29(6):1256-1276. doi:10.1183/09031936.00101006 DOI: https://doi.org/10.1183/09031936.00101006

Turner RD, Birring SS. Chronic cough as a disease. ERJ Open Res. 2024;10(6). doi:10.1183/23120541.00459-2024 DOI: https://doi.org/10.1183/23120541.00459-2024

Kaplan AG. Chronic cough in adults: make the diagnosis and make a difference. Pulm Ther. 2019;5(1):11-21. doi:10.1007/s41030-019-0089-7 DOI: https://doi.org/10.1007/s41030-019-0089-7

Chung KF, Pavord ID. Prevalence, pathogenesis, and causes of chronic cough. Lancet. 2008;371(9621):1364-1374. doi:10.1016/s0140-6736(08)60595-4 DOI: https://doi.org/10.1016/S0140-6736(08)60595-4

Pratter MR. Overview of common causes of chronic cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):59s-62s. doi:10.1378/chest.129.1_suppl.59S DOI: https://doi.org/10.1378/chest.129.1_suppl.59S

French CL, Irwin RS, Curley FJ, Krikorian CJ. Impact of chronic cough on quality of life. Arch Intern Med. 1998;158(15):1657-1661. doi:10.1001/archinte.158.15.1657 DOI: https://doi.org/10.1001/archinte.158.15.1657

Brister D, Khan S, Abraham T, Laventure S, Sahakian S, Juliá B, et al. Burden of disease associated with refractory and unexplained chronic cough in Canada: results from a National survey. Lung. 2024;202(4):415-424. doi:10.1007/s00408-024-00714-1 DOI: https://doi.org/10.1007/s00408-024-00714-1

Dubin S, Griffin D. Lung cancer in non-smokers. Mo Med. 2020;117(4):375-379.

Rai DK, Sharma P, Karmakar S, Thakur S, Ameet H, Yadav R, et al. Approach to post COVID-19 persistent cough: a narrative review. Lung India. 2023;40(2):149-154. doi:10.4103/lungindia.lungindia_250_22 DOI: https://doi.org/10.4103/lungindia.lungindia_250_22

Morice A. Chronic cough: symptom, sign or disease? ERJ Open Res. 2024;10(4). doi:10.1183/23120541.00449-2024 DOI: https://doi.org/10.1183/23120541.00449-2024

Kum E, Brister D, Diab N, Wahab M, Abraham T, Sahakian S, et al. Canadian health care professionals' familiarity with chronic cough guidelines and experiences with diagnosis and management: a cross-sectional survey. Lung. 2023;201(1):47-55. doi:10.1007/s00408-023-00604-y DOI: https://doi.org/10.1007/s00408-023-00604-y

Global Initiative for Asthma. Global Strategy fr Asthma Management and Prevention 2024 [Available from: https://ginasthma.org/.

Mello CJ, Irwin RS, Curley FJ. Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause. Arch Intern Med. 1996;156(9):997-1003. DOI: https://doi.org/10.1001/archinte.1996.00440090103010

Dicpinigaitis PV. Angiotensin-converting enzyme inhibitor-induced cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):169s-173s. doi:10.1378/chest.129.1_suppl.169S DOI: https://doi.org/10.1378/chest.129.1_suppl.169S

Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):1s-23s. doi:10.1378/chest.129.1_suppl.1S DOI: https://doi.org/10.1378/chest.129.1_suppl.1S

Pizzichini MM, Pizzichini E, Parameswaran K, Clelland L, Efthimiadis A, Dolovich J, et al. Nonasthmatic chronic cough: no effect of treatment with an inhaled corticosteroid in patients without sputum eosinophilia. Can Respir J. 1999;6(4):323-330. doi:10.1155/1999/434901 DOI: https://doi.org/10.1155/1999/434901

Xu Q, Lu T, Song Z, Zhu P, Wu Y, Zhang L, et al. Efficacy and safety of montelukast adjuvant therapy in adults with cough variant asthma: a systematic review and meta-analysis. Clin Respir J. 2023;17(10):986-997. doi:10.1111/crj.13629 DOI: https://doi.org/10.1111/crj.13629

Hyfe. Continuous Validated Cough Monitoring 2024 [Available from: https://www.hyfe.com/.

Dicpinigaitis PV, Alva RV. Safety of capsaicin cough challenge testing. Chest. 2005;128(1):196-202. doi:10.1378/chest.128.1.196 DOI: https://doi.org/10.1378/chest.128.1.196

Spinou A, Birring SS. An update on measurement and monitoring of cough: what are the important study endpoints? J Thorac Dis. 2014;6(Suppl 7):S728-734. doi:10.3978/j.issn.2072-1439.2014.10.08

Satia I, Wahab M, Kum E, Kim H, Lin P, Kaplan A, et al. Chronic cough: Investigations, management, current and future treatments. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine. 2021;5(6):404-416. doi:10.1080/24745332.2021.1979904 DOI: https://doi.org/10.1080/24745332.2021.1979904

Sasieta HC, Iyer VN, Orbelo DM, Patton C, Pittelko R, Keogh K, et al. Bilateral thyroarytenoid botulinum toxin type a injection for the treatment of refractory chronic cough. JAMA Otolaryngol Head Neck Surg. 2016;142(9):881-888. doi:10.1001/jamaoto.2016.0972 DOI: https://doi.org/10.1001/jamaoto.2016.0972

Abdulqawi R, Smith J, Dockry R, Oshodi J, Murdoch R, Woodcock A. Effect of lidocaine and its delivery in chronic cough. Eur Respir J. 2012;40:P2171.

Birring SS, Wijsenbeek MS, Agrawal S, van den Berg JWK, Stone H, Maher TM, et al. A novel formulation of inhaled sodium cromoglicate (PA101) in idiopathic pulmonary fibrosis and chronic cough: a randomised, double-blind, proof-of-concept, phase 2 trial. Lancet Respir Med. 2017;5(10):806-815. doi:10.1016/s2213-2600(17)30310-7 DOI: https://doi.org/10.1016/S2213-2600(17)30310-7

Maher TM, Avram C, Bortey E, Hart SP, Hirani N, Molyneux PL, et al. Nalbuphine tablets for cough in patients with idiopathic pulmonary fibrosis. NEJM Evid. 2023;2(8):EVIDoa2300083. doi:10.1056/EVIDoa2300083 DOI: https://doi.org/10.1056/EVIDoa2300083

Published

2025-06-05

How to Cite

1.
Kaplan A. Chronic Cough, a New Disease, Not Just An Old Problem . Can Prim Care Today [Internet]. 2025 Jun. 5 [cited 2025 Jun. 7];3(1):13–20. Available from: https://canadianprimarycaretoday.com/article/view/3-1-Kaplan

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