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Unexplained (Idiopathic) Cough

ACCP Evidence-Based Clinical Practice Guidelines

Correspondence to: Melvin R. Pratter, MD, FCCP, the Robert Wood Johnson School of Medicine at Camden, Suite 312, 3 Cooper Plaza, Camden, NJ 08103; e-mail: Pratter-Melvin{at}cooperhealth.edu

Objective: To review the literature on unexplained cough, previously referred to as idiopathic cough.

Methods: Search of MEDLINE (through May 2004) for studies published in the English language since 1980 on human subjects using the medical subject heading terms "cough," "unexplained cough," and "idiopathic cough." We selected case series and prospective descriptive clinical trials. We also obtained any references from these studies that were pertinent to the topic.

Results: The diagnosis of unexplained (idiopathic) cough should only be considered after a thorough diagnostic and treatment approach for the most common causes of cough has been completed and uncommon causes have been adequately evaluated Unless this is done, it is likely that many patients with a definable cause of cough will be misdiagnosed as having "unexplained cough."

Conclusion: The diagnosis of unexplained cough is probably made too often based on an inadequate diagnostic workup or treatment course to determine the specific cause of cough. Nevertheless, there may be a group of patients in whom none of the usual explanations for cough may be present. For this group, the committee unanimously recommends using the diagnostic term unexplained cough, rather than idiopathic cough.

Key Words: idiopathic cough • lymphocytic bronchitis • mast cells • unexplained cough

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