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Chronic cough

This page refers to a cough present for at least 8 weeks with no clear cause and which may be dry or moist. If chronic sputum production please consider Bronchiectasis / chronic suppurative lung disease (CSLD).

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • No category 1 criteria

Category 2

Appointment within 90 days is desirable

  • Recurrent cough syncope in the presence of cough persisting for >8 weeks

Category 3

Appointment within 365 days is desirable

  • Cough persisting for > 8 weeks despite clinical assessment including CXR and spirometry, and management of associated contributory factors as specified in Other important information for referring practitioners.

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Definitions

  • Subacute cough is a cough present for 3 to 8 weeks
  • Chronic cough has been present for over 8 weeks.

There are many causes of persistent cough. These can be categorised into:

  • Respiratory (Infective, non-asthmatic eosinophilic bronchitis, related to chronic lung disease (COPD, Bronchiectasis, restrictive LD, occupational LD, asthma), cancer, related to pleural disease, foreign body, allergic)
  • ENT (due to tonsillar /adenoidal infection, sinusitis/ rhinitis –PN drip, laryngeal/tracheal)
  • Gastrointestinal (GORD, tracheo-oesophageal fistula)
  • Cardiac (heart failure)
  • Drug related (ACEI, aspirin, beta blockers)
  • Thromboembolic (pulmonary embolism/infarction)
  • Neurological/neuromuscular (degenerative (MS, MND, nerve palsies, Stroke related)
  • Psychogenic

Acute cough (less than 3 weeks) does not usually require investigation unless there is persistent fever, haemoptysis, chest pain weight loss. It should be possible to arrive at a diagnosis in most cases by careful history and examination with directed investigations. If considering referral try to arrive at a probable diagnosis as this will determine which specialty to refer to.

Other important information for referring practitioners

Not an exhaustive list

  • Chronic cough is frequently associated with underlying airway hypersensitivity. Many other factors can be contributory, categorised into:
    • respiratory
    • drug related (ACE inhibitors)
    • gastrointestinal (symptomatic GORD)
    • ENT (symptomatic rhinosinusitis; laryngeal hypersensitivity)

Treatment options:

  • ACE inhibitors should be ceased for at least 6 weeks, and an alternate medication substituted as required (e.g. angiotensin 2 receptor antagonists).
  • Ensure asthma, symptomatic acid reflux (heartburn), sino-nasal disease, and unresolved infectious bronchitis and have been considered and treated appropriately.
    • Commence a four-week trial of inhaled steroids for evidence of asthma (typical symptoms, atopy, obstructive spirometry, raised blood eosinophils or FeNO).
    • Four-week trial of PPI if symptoms of heartburn.
    • Consider a six-week trial of intra nasal steroid for features of chronic rhinosinusitis.

NOTE: in the absence of specific diagnostic features, ‘blind’ trials of treatment of secondary diseases (asthma, GORD, rhinosinusitis, etc) are no longer advocated for chronic cough.

Referral requirements

A referral may be rejected without the following information.

Essential referral informaiton

  • Associated effects such as syncope, incontinence, SOB
  • FBC, ELFT and ESR
  • CT chest
  • History of smoking, occupational exposures, respiratory or ENT problems, or GORD
  • Medication history, especially including ACE inhibitor use (which should be avoided), and results of treatment trials as defined in Other important information for referring practitioners
  • Relevant examination findings

Additional referral information

  • Spirometry and FeNO result (exhaled nitric oxide) if available
  • CXR, if performed
  • Previous gastroscopy findings or ENT assessment details where relevant

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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