GPAtlas🧭 When to suspect
Cough is one of the commonest presentations in primary care and the final pathway of more than a hundred conditions.
Start with duration:
• An acute cough (< 3 weeks) is usually a self-limiting viral upper respiratory tract infection.
• A subacute cough (3–8 weeks) is most often post-infectious.
• A chronic cough (> 8 weeks) warrants investigation for a specific cause.
NICE frames acute cough as settling within 3–4 weeks without antibiotics.
So screen for red flags in everyone (particularly smokers and those aged ≥ 40), resist unnecessary antibiotics in acute cough, and find and treat the underlying cause in chronic cough, not just suppress the symptom.
| Duration | Typical causes | Initial approach |
|---|---|---|
| Acute (< 3 weeks) | • Viral upper respiratory tract infection (URTI), acute bronchitis • Less commonly pneumonia, PE |
• Reassure, self-care, safety-net • Antibiotics only if indicated |
| Subacute (3–8 weeks) | Post-infectious (including post-COVID and pertussis), bronchial hyper-reactivity | • Usually settles • Reassess and consider pertussis |
| Chronic (> 8 weeks) | • ACE-inhibitor cough, asthma/eosinophilic airway disease, upper airway cough syndrome, reflux • Exclude serious pathology |
Chest X-ray + spirometry, then treat the cause with time-limited trials |
Raise suspicion of serious pathology in anyone with a persistent or unexplained cough, especially:
• A smoker or ex-smoker aged ≥ 40.
• A relevant occupational exposure (dust, asbestos, chemicals).
• Any red-flag feature.
A chronic cough must never be written off as COVID-19 or a “smoker's cough” without a chest X-ray.
Source: NICE NG120 · NICE NG12
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