The success of treating a chronic cough lies in the doctor’s ability to evaluate and eliminate the causative factors. It doesn’t rely on symptomatic relief measures such as cough suppressants. Most cough mixtures are, in fact, ineffective in these situations.
Directed treatment of the underlying cause is indicated if a specific cause is identified. In situations where the possibility of post-nasal drip exists, but no clear signs are present, a trial of therapy is entirely appropriate.
Often, an empiric approach to treatment is recommended. This involves treating the possible causes one step at a time.
Sometimes two conditions co-exist, e.g. asthma and a post-nasal drip. Both conditions may contribute to the cough; alternatively, the cough may be caused by only one of these conditions. Treatment of both conditions is usually required, although just treating the nose may be sufficient.
The process of investigation and treatment can be slow and unsatisfying for the patient and the doctor. In addition to a lot of patience from both parties, a thorough and systematic approach is required to get to the bottom of a chronic cough, where simple treatments have had no effect.
Reviewed by Professor Richard van Zyl-Smit, Head of the Lung Clinical Research Unit at the University of Cape Town. MBChB, MRCP(UK), Dip HIV(Man), MMED, FCP(SA), Cert Pulm(SA), PhD. February 2018.