chronic cough in adults (≥8 weeks): structured assessment + referral

Define chronic cough as cough lasting ≥8 weeks. The key is to identify red flags, get a baseline assessment (often including CXR and spirometry), and treat common causes systematically (ACE-inhibitor cough, asthma/eosinophilic airway disease, upper airway cough syndrome, GORD).

• Haemoptysis, weight loss, persistent fever/night sweats, significant breathlessness, chest pain, hoarseness, recurrent pneumonia.
• Abnormal chest examination, new clubbing, supraclavicular nodes.
• High-risk smoking history or occupational exposure.

Action: follow local suspected lung cancer pathways and arrange urgent CXR/CT as indicated; do not “trial and error” if red flags are present.

• Medication review: ACE inhibitor cough can occur weeks–months after starting; consider stopping and reassessing after ~4 weeks (if clinically safe).
• Smoking/vaping status and occupational exposures.
• Investigations: many pathways recommend CXR and spirometry (± bronchodilator reversibility) for cough persisting beyond a few weeks.

• Upper airway cough syndrome (post-nasal drip/rhinitis): nasal steroids + antihistamine if allergic features.
• Asthma / eosinophilic airway disease: wheeze, variable symptoms; consider inhaled corticosteroid trial if supported by spirometry/FeNO/local pathway.
• GORD: heartburn/regurgitation; lifestyle + PPI trial may help some patients, but avoid long PPI courses without review.
• Chronic infection / bronchiectasis suspicion: daily sputum, recurrent infections → consider specialist referral.

Safety-net: if no improvement after sequential structured trials (and baseline tests), refer to respiratory clinic per local pathway.