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Last updated: 30 March, 2020 15:59pm

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Chronic Cough – Information for GPs

Referral Criteria/Commissioning position

Indications for referral:

  • Additional sinister features to rule our malignancy – Two Week Wait Rule
  • Failure of simple conservative measures
  • Failure of treatment of Laryngo Pharyngeal Reflux
  • Concern that there is a vocal cord problem

An ENT referral allows nasendoscopy. Without sinister features this is likely to confirm LPR or pick up some other source of limitation of the vocal cords such as smoking.

Red flag symptoms

  • Rule out non ENT sinister feature. Check CXR
  • In the ENT context:-
    • Odynophagia
    • Recent onset dysphagia
    • Persistent constant hoarse voice
    • Weight loss
    • Risk factors: Age, smoker, heavy drinker

Investigations prior to referral

CXR

Information to include in referral letter

The GP referral letter should contain:

  • Specific information for condition – length of time of condition, timing of cough through day, any other feature of LPR such as globus, hoarseness, catarrh
  • Employment
  • Treatments and interventions tried including the results
  • Drug history (prescribed and non-prescribed)
  • Relevant past medical/surgical history
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption
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