Unexplained
cough is a diagnosis of exclusion that should not be made until a thorough validated diagnostic evaluation is performed, specific and appropriate validated treatments have been tried and failed, and uncommon causes have been ruled out. When
chronic cough remains troublesome after the initial work up, determine that a protocol has been used that has been shown to lead to successful results. If such a protocol has been used, next consider whether or not pitfalls in management have been avoided. If they have been, the frequency of truly unexplained
chronic cough usually should not exceed 10%. While patients with truly unexplained
coughs have an overly sensitive
cough reflex, the mere presence of an overly sensitive
cough reflex does not by itself explain why they do not get better, because most patients with
chronic cough, even those who respond to treatment and get better, have demonstrable heightened
cough sensitivity. Management options include referral to a
cough clinic with interdisciplinary expertise,
speech therapy, and self-limited trials of drugs, preferentially with those shown to be effective in randomized, double-blind placebo-controlled trials in patients with unexplained
chronic cough.