Differentiating Cough Etiologies: A Clinical Algorithmic Approach

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Cough is a physiological response to mechanical and chemical stimuli caused by irritation of cough receptors located primarily in the epithelium of the upper and lower respiratory tracts, as well as the pericardium, esophagus, diaphragm, and stomach.1 Globally, the prevalence of chronic cough ranges from 5% to 40%, while in India it is 2.4–6% in rural areas and 1.7–5.4% in urban populations. Identifying the etiology of chronic cough is challenging, with upper airway cough syndrome (UACS), asthma including cough variant asthma (CVA), eosinophilic bronchitis (EB), and gastroesophageal reflux disease (GERD) being the most common causes in non-smokers with normal chest radiographs.2 Cough is a vital defensive reflex that clears airway secretions, particulates, and pathogens, protecting against aspiration. Pharmacological management includes central-acting antitussives such as Pholcodeine, Ethylmorphine, Noscapine, Dextromethorphan, and Chlophedianol; peripheral-acting agents like Benproperine, Benzonatate, Moguisteine, Levodropropizine, and Levocloperastine; and adjuvants including Chlorpheniramine, Diphenhydramine, Bilastine, Phenylephrine, and Promethazine, which suppress the cough reflex and enhance symptom control.