Beyond a Symptom: A Mechanism-Based Multidisciplinary Framework for the Diagnosis and Management of Chronic Cough

Chronic cough may persist despite appropriate treatment of associated conditions, creating uncertainty about the relevance of coexisting abnormalities and therapeutic priorities. This evidence-informed narrative review draws on searches of PubMed/MEDLINE, Scopus, and Web of Science and relevant guidelines to propose a mechanism-based multidisciplinary framework for adults, particularly those with refractory or unexplained chronic cough. The nine-step pathway integrates established disease assessment, characterization of cough hypersensitivity and laryngeal involvement, provisional weighting of treatable traits and modifiable contributors, targeted multidisciplinary input, individualized intervention, and reassessment. Within this proposed framework, findings are considered dominant, contributory, incidental, or currently inactive according to converging clinical evidence; insufficiently evaluated findings remain uncertain. Treatment response is interpreted by distinguishing improvement in the targeted trait from improvement in cough. Discordant or inadequate responses prompt reassessment of treatment adequacy and mechanistic relevance. Patient-reported outcomes, objective cough monitoring when available, and trait-specific measures inform treatment evaluation and subsequent re-phenotyping. The weighting categories and integrated pathway represent the authors’ conceptual synthesis and have not been prospectively validated. Their reproducibility, feasibility, clinical effectiveness, and cost-effectiveness require evaluation.