A 54 year-old man with a chronic cough--Following referral: a secondary care perspective from the UK.

Clinical scenario A 54 year-old man consults about a long-standing cough: his wife encouraged him to attend as she was tired of hearing him cough all the time. He is a bit vague about when it started, but it must be ‘nearly a year’. He has consulted his usual general practitioner about the cough three times. Eight months ago he presented with a ‘chesty’ cough associated with a feverish illness and an upper respiratory tract infection; he was prescribed a course of antibiotics which he thinks might have slightly improved the cough, though it did not fully resolve. Two subsequent consultations resulted in a further course of antibiotics and a trial of a salbutamol inhaler, neither of which appear to have made any difference. The clinical notes record that his chest was ‘clear’ at each of these consultations. He describes himself as ‘generally well’, though he has been tired recently which he attributes to the long hours he is working. He smoked for about 15 years but quit in his mid-thirties.