Refer patients with chronic cough to a respiratory specialist if the diagnosis is uncertain, if there has been a failure of empirical treatment, or if the cough is refractory and does not respond to treatment trials NICE CKS.
Specifically, referral is indicated when the cough does not respond to treatment, partially responds (indicating multiple causes), or if the diagnosis remains uncertain NICE CKS.
Additional reasons for referral include suspicion of underlying conditions such as interstitial lung disease, lung cancer, or other significant respiratory pathology, especially if clinical features suggest these diagnoses NICE CKS.
People with clinical features of somatic cough syndrome or tic cough should also be referred for specialist assessment NICE CKS.