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Chronic Cough Pathway 

This appendix provides a structured clinical framework for the assessment and management of patients with chronic cough, adapted for use across South London respiratory services. It incorporates practical guidance on initial assessment, empirical treatment trials, escalation to advanced diagnostics, and referral for specialist input — including speech and language therapy and neuromodulator options.

 

For comprehensive national recommendations, refer to the latest:

British Thoracic Society (BTS) Clinical Statement on Chronic Cough in Adults (2023)

 

This guidance aligns closely with the multidisciplinary cough clinic pathway at King's College Hospital.

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  1. Initial Assessment:

  • Comprehensive clinical history and examination.

  • Baseline investigations: Chest X-ray, spirometry, FeNO.

2. Empirical Treatment Trials:

  • Postnasal drip: Antihistamines, nasal corticosteroids, saline douche.

  • Asthma/eosinophilic bronchitis: Trial of inhaled corticosteroids.

  • GERD: 8–12 weeks of PPI therapy and lifestyle advice.

3. Advanced Diagnostics:

  • HRCT chest if treatment response is poor.

  • Bronchoscopy if lesion suspected.

  • Consider ACE inhibitor use, smoking, chronic bronchitis.

4. Specialist Interventions:

  • Neuromodulators: e.g. Gabapentin, Amitriptyline.

  • Speech & Language Therapy for cough suppression.

5. Multidisciplinary Review:

  • Cases discussed in MDT with respiratory, speech therapy and specialist teams.

6. Research Trials:

  • Eligible patients may be offered enrolment in clinical studies (e.g. P2X3 antagonists like Gefapixant).

⚠️ Disclaimer

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This guide is intended as a helpful reference for respiratory trainees rotating through South London hospitals.

While every effort has been made to ensure the information is accurate and up to date as of May 2025 and changes may occur and some content may become outdated or include errors.

Please confirm referral processes and contact details locally and always follow up referrals through appropriate channels. Clinical decisions should be guided by local protocols, discussion with colleagues, and consultant supervision. This guide is not a substitute for local trust guidelines or official policies. The authors cannot accept responsibility for any inaccuracies or outcomes resulting from the use of this document.

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