Medical University of South Carolina, Charleston, 29425, USA.
Am Fam Physician. 2011 Oct 15;84(8):887-92.
Initial evaluation of the patient with chronic cough (i.e., of more than eight weeks' duration) should include a focused history and physical examination, and in most patients, chest radiography. Patients who are taking an angiotensin-converting enzyme inhibitor should switch to a medication from another drug class. The most common causes of chronic cough in adults are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, alone or in combination. If upper airway cough syndrome is suspected, a trial of a decongestant and a first-generation antihistamine is warranted. The diagnosis of asthma should be confirmed based on clinical response to empiric therapy with inhaled bronchodilators or corticosteroids. Empiric treatment for gastroesophageal reflux disease should be initiated in lieu of testing for patients with chronic cough and reflux symptoms. Patients should avoid exposure to cough-evoking irritants, such as cigarette smoke. Further testing, such as high-resolution computed tomography, and referral to a pulmonologist may be indicated if the cause of chronic cough is not identified. In children, a cough lasting longer than four weeks is considered chronic. The most common causes in children are respiratory tract infections, asthma, and gastroesophageal reflux disease. Evaluation of children with chronic cough should include chest radiography and spirometry.
对慢性咳嗽（即持续超过八周）患者的初始评估应包括重点病史和体格检查，并且在大多数患者中，还应包括胸部 X 光检查。正在服用血管紧张素转换酶抑制剂的患者应换用另一种药物类别的药物。成人慢性咳嗽最常见的原因是上气道咳嗽综合征、哮喘和胃食管反流病，单独或联合存在。如果怀疑上气道咳嗽综合征，可试用减充血剂和第一代抗组胺药。应根据经验性吸入支气管扩张剂或皮质类固醇治疗的临床反应来确诊哮喘。对于有慢性咳嗽和反流症状的患者，应在进行检查之前开始进行胃食管反流病的经验性治疗。患者应避免接触引起咳嗽的刺激物，如香烟烟雾。如果无法确定慢性咳嗽的病因，则可能需要进行进一步的检查，例如高分辨率计算机断层扫描，并转介给肺病专家。对于儿童，持续时间超过四周的咳嗽被认为是慢性咳嗽。儿童最常见的原因是呼吸道感染、哮喘和胃食管反流病。对慢性咳嗽儿童的评估应包括胸部 X 光检查和肺功能检查。
