Cough in Children and Adults: Diagnosis, Assessment and Management (CICADA). Summary of an updated position statement on chronic cough in Australia

In reply: We thank Prentice1 for his comments on the CICADA position statement on chronic cough in Australia.2 He highlights some rare causes of chronic cough that we agree have not received much attention regarding cough pathogenesis. He brings to the attention of readers the potential for neurological mechanisms to play a role in driving chronic cough, including Arnold's nerve irritation, giant cell arteritis, and other very rare neurological conditions.

The position statement aims to highlight the most prevalent conditions associated with chronic cough in both adults and children.2 It outlines the systematic or algorithm‐based approach to the problem that general practitioners should use, beginning with thorough history taking and targeted investigations. These investigations are based on clinical probability, and given the rare conditions discussed by Prentice,1 it would be difficult to make a broad statement that all patients with chronic cough should have a comprehensive neurological examination and measurement of erythrocyte sedimentation rate as suggested. However, in the case report discussed,3 there were pointers to an underlying cause, including a hoarse voice, as listed in Box 6 of the position statement summary as a red flag indicating serious underlying pathology,2 and the algorithm would recommend pursuing diagnosis and management as appropriate for this pointer. If the cough does not resolve, the algorithm recommends referral to a cough specialist.

Therefore, while the issues raised are important, they are certainly very rare and their consideration is probably most relevant in patients with unexplained chronic cough referred to specialists for assessment, and Prentice's letter should be noted in this context.