Chronic Persistent Cough in Adults - Diagnosis

Authored by Dr Mary Harding, 11 May 2017

Patient is a certified member of
The Information Standard

Reviewed by:
Prof Cathy Jackson, 11 May 2017

When you have a lingering cough and go to see a doctor, first they will want to ask you some questions (take a history). These might include:

  • Do you smoke?
  • Does anyone in your family have any chest-related conditions?
  • Have you ever had asthma or hay fever?
  • Do you get heartburn?
  • Is your nose congested or runny?
  • Have you travelled abroad recently?
  • Questions about the cough: How long have you had it? When did it start? Did it start after an infection? Do you bring up any phlegm or blood when you cough?
  • Do you have any other symptoms? (Such as weight loss, being short of breath, night sweats or pains in your chest or shoulder.)
  • What is/was your job?
  • Are you on any medication?

The doctor will then want to examine you. What is checked may depend on your answers to the questions above. Examination might include:

  • Looking in your throat and nose.
  • Listening to your chest.
  • Feeling your neck and upper chest for lymph nodes.
  • Looking at your fingernail shape (this can indicate certain lung conditions).
  • Checking your temperature.
  • Feeling your tummy.
  • Checking your ankles for swelling.

The doctors may then do some further tests in the surgery, including:

  • Checking your oxygen levels. This is done with a pulse oximeter, which attaches to your finger and measures your pulse and oxygen levels.
  • Checking your peak flow. You will be asked to blow into a tube (a peak flow meter) to see how well your lungs work.
  • Spirometry. This is a more complex test of your lung function and you would be asked to come back to have this done in another appointment.

Other than the tests described above, you may need further tests, depending on what has been found so far. You will almost certainly have a chest X-ray. If you produce any phlegm when you cough this will be sent off for analysis to see if it contains any germs, indicating infection. Some blood tests may be helpful.

If any of these tests show abnormalities in your lungs, you may be referred to a specialist for further investigations. These might include:

  • A CT scan
  • A bronchoscopy. A camera is passed with a tube into your airways, so that they can be seen and samples from the inside can be taken.

Other tests may be suggested if reflux or a nasal/sinus problem is suspected, and your cough doesn't clear up on treatment. For example, this might include an endoscopy. If a heart problem is suspected, further heart investigations such as an echocardiogram may be advised.

Further reading and references

  • Cough; NICE CKS, June 2015 (UK access only)

  • Barraclough K; Chronic cough in adults. BMJ. 2009 Apr 24338:b1218. doi: 10.1136/bmj.b1218.

  • Johnstone KJ, Chang AB, Fong KM, et al; Inhaled corticosteroids for subacute and chronic cough in adults. Cochrane Database Syst Rev. 2013 Mar 28(3):CD009305. doi: 10.1002/14651858.CD009305.pub2.

  • Gibson PG, Vertigan AE; Management of chronic refractory cough. BMJ. 2015 Dec 14351:h5590. doi: 10.1136/bmj.h5590.

  • Faruqi S, Murdoch RD, Allum F, et al; On the definition of chronic cough and current treatment pathways: an international qualitative study. Cough. 2014 May 2910:5. doi: 10.1186/1745-9974-10-5. eCollection 2014.

Hello, I have had a cough for about 2 years now and have been to the GP and hospital many a times but they  just give me some tablets that don't work or think i'm lying (one said it was a habit and...

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