Chronic Cough

Voice Institute of New York Chronic Cough Form

Is your main problem COUGH?__________ For how many years?________

When your cough began, had you had respiratory infection, cold, the flu, or other illness? ________

Had a chest x-ray within the last two years?_______;

Normal?________

Have you seen a pulmonologist (lung doctor)?__________

Are you on blood pressure medicine?_________;

Which?_______

Chronic Cough Index  (CCI) (R=Reflux, N=Neurogenic)

• Do you awaken from a sound sleep coughing violently, with or without trouble breathing?
• Do you have choking episodes when you cannot get enough air, gasping for air?
• Do you usually cough when you lie down into the bed, or when you just lie down to rest?
• Do you usually cough after meals or eating?
• Do you cough when (or after) you bend over?
• Do you more-or-less cough all day long?
• Does change of temperature make you cough?
• Does laughing or chuckling cause you to cough?
• Do fumes (perfumes, automobile fumes, burnt toasts, etc.) cause you to cough?
• Does speaking, singing, or talking on the phone cause you to cough?

This Chronic Cough Index is reproduced from The Chronic Cough Enigma by the permission of Katalitix Media and Dr. Jamie Koufman.