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Excessive Coughing: Causes, Red Flags & When to See a Doctor

Cough is a protective reflex (airway clearance). Chronic cough = >8 weeks adults, >4 weeks children. Requires systematic evaluation.

Common Causes (by Duration)

  • Acute (<3 wks): URI, bronchitis, COVID, flu, pneumonia, ACEi-induced
  • Subacute (3–8 wks): Post-infectious, pertussis, post-nasal drip
  • Chronic (>8 wks): Top 3: UACS (post-nasal drip), asthma, GERD. Also: non-asthmatic eosinophilic bronchitis, bronchiectasis, COPD, TB, lung cancer, medication (ACEi, ARB), habit cough

Red Flags (Urgent Evaluation)

  • Hemoptysis (blood)
  • Weight loss, night sweats, fever
  • Dyspnea, hoarseness >2 wks
  • New cough in smoker >40 pack-years
  • Immunosuppression
  • Chest pain

Diagnostic Approach

  1. History: timing, triggers, sputum, meds, exposures, travel
  2. Exam: vitals, lungs, ENT, neck
  3. CXR (if chronic or red flags)
  4. Spirometry ± bronchodilator (asthma/COPD)
  5. Empiric trials: antihistamine/nasal steroid (UACS), inhaled steroid (asthma), PPI (GERD)
  6. Specialist referral if refractory

Key Point

ACE inhibitors cause cough in 10–20% (bradykinin accumulation). Switch to ARB if suspected. Most chronic cough is multi-factorial.

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