GPAtlas🧭 When to suspect
Cough is one of the commonest presentations in primary care and the final pathway of more than a hundred conditions. The single most useful discriminator is 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; and a chronic cough (> 8 weeks) warrants investigation for a specific cause. NICE frames acute cough as settling within 3–4 weeks without antibiotics.
The three clinical tasks are therefore to screen for red flags in everyone (particularly smokers and those aged ≥ 40), to resist unnecessary antibiotics in acute cough, and to find and treat the underlying cause in chronic cough rather than simply suppressing the symptom.
| Duration | Typical causes | Initial approach |
|---|---|---|
| Acute (< 3 weeks) | Viral 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), or 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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