acute cough workup

Patients with mucosal thickening should be treated for sinusitis. They are helpful indicators to guide your differential diagnosis. There are no clearly effective treatments for the cough of acute bronchitis. He feels slightly under the weather because the cough is hindering his sleep. He is coughing up slight amounts of yellow-green sputum, once with a slight streak of blood. The history is also important for discovering if the patient is from an area where diseases that can cause cough (e.g., tuberculosis) are prevalent; has systemic signs of disease (e.g., fever, sweating, weight loss); or has a history of cancer, tuberculosis, or acquired immune deficiency syndrome. Immediate, unlimited access to all AFP content. You make a mental note to consider a chest x-ray scan if his cough persists, he loses weight, or he remains unwell. Thank you for your interest in spreading the word on The College of Family Physicians of Canada. A cough in children may be either a normal physiological reflex or due to an underlying cause. He has not traveled out of town for 2 years. A chest X-ray can help determine if you have pneumonia or another condition that may explain your cough. Although cough suppressants and antihistamines have not specifically been well studied in patients with acute bronchitis, the former can be effective in chronic bronchitis and the latter provide some relief for patients with colds. On a typical day, a family physician will see at least one patient presenting with cough. Ears, nose, and throat examination findings are normal; no cervical or axillary lymphadenopathy is present. 75/No. The first step in the treatment of acute cough is to determine if the cause of the cough is one of these serious conditions or an acute upper respiratory infection (i.e., common cold), lower respiratory tract infection, or an exacerbation of a preexisting condition (e.g., asthma, bronchiectasis, chronic obstructive pulmonary disease [COPD], or upper airway cough syndrome). ; for the American College of Chest Physicians. A cough is considered "acute" if it lasts less than three weeks. Evidence of infection should be followed by attempts to make a microbial diagnosis. This article does not address the initial approach to patients with chronic cough that is due to obvious causes, such as smoking, pneumonia, bronchitis, post-inflammatory cough or therapy with angiotensin converting enzyme (ACE) inhibitors, or relatively uncommon but easily diagnosable causes such as tuberculosis or lung cancer. If the radiographic findings are abnormal, treatment depends on the specific finding. His patient record mentions that he is a smoker. Because acute cough has a different range of causes in adults than it does in children, adults should be assessed and treated differently. / Vol. Acute bronchitis often starts because of another illness, such as a cold or the flu. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Our limited list of … If the cough began with an upper respiratory tract infection and has lingered, it is usually considered a postinfectious cough. He felt a bit shivery when it began, but that has passed. Diagnosing pneumonia by history and physical examination, Guideline for the management and treatment of acute bronchitis, The treatment of acute bronchitis by general practitioners in the UK. The patient will seem unusually ill (eg, pneumonia, influenza) or short of breath (eg, congestive heart failure, SARS, acute asthma). Choose a single article, issue, or full-access subscription. If the patient has persistent nasal symptoms, it is appropriate to begin a topical nasal steroid. Because recent Health Canada regulations have prohibited smoking in the taxi, he has actually reduced his daily cigarette consumption from 20 to about 10. Your careful history has excluded any likely serious causes for Mr Smith’s acute cough; in particular, your careful clinical examination has ruled out asthma and CAP. You recommend that he return to see you if he gets worse, or does not improve, at the end of that time period. If the patient has complete or partial resolution of cough after one to two weeks of antihistamine/decongestant therapy, then it is assumed that upper airway cough syndrome was the cause and therapy should be continued. If the cough began during or shortly after they experienced symptoms of an acute URTI, it may be postinfectious. Some doctors have questioned whether bronchitis is a clear diagnostic entity; maybe it is just a cold on the chest. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Coloured sputum cannot be used to predict whether an infection is viral or bacterial. Results of a cross-sectional postal survey, Antibiotic treatment of acute bronchitis in smokers: a systematic review, Factors associated with antibiotic use in acute bronchitis, Managing type 2 diabetes in primary care during COVID-19, Effectiveness of dermoscopy in skin cancer diagnosis, http://www.cfpc.ca/Canadianfamilyphysician/, Copyright© the College of Family Physicians of Canada. A positive challenge usually warrants trial treatment for asthma and clinical monitoring. afpserv@aafp.org for copyright questions and/or permission requests. The first step in the workup of patients who present with subacute cough is to determine whether they have a postinfectious cough. ... diagnosis or treatment. Acute coughs usually last around two weeks. His job entails long hours in a confined space with many different people, which would certainly increase his risk of picking up an infection. Although he has smoked for 20 years, he felt fine until 9 days ago; he has not noticed any weight loss, chest pain, or hemoptysis. It is considered "chronic" if it lasts longer than eight weeks (four weeks in children). Mr Smith says he does not, as far as he knows, have asthma or any heart troubles. 26 Up to that time, and unless there are signs of super-infection or other complications such as painful pleural inflammation, cough seems to be best managed with simple breathing control exercises 28 (see box 2) and medication where indicated (such as proton pump inhibitors if reflux is suspected). He is not currently taking any medication and has no chronic diseases. However, most GPs are worried that they might miss a case of acute community-acquired pneumonia (CAP), which still has relatively high mortality, especially among the elderly.6 The criterion standard for diagnosing CAP is the presence of consolidation on the chest radiograph, but GPs cannot be ordering chest x-ray scans for every patient with acute cough. question for acute, subacute, and chronic cough. Cough should resolve within four weeks of therapy. The most common symptom is a cough. Adapted with permission from Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, et al. Non-life-threatening acute cough (URI, acute bronchitis): Nonpharmacological treatment . What can I do to manage my cough? NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Two clarifications are necessary. He accepts your explanation that antibiotics will be of no use, and you have suggested a short-term cough suppressant and antihistamine to relieve his annoying symptoms so that he can continue working. Any patient who responds only partially or not at all to the above therapies should be empirically treated for GERD. Most adults who present to their FPs with cough are looking for relief of their symptoms.16 Unless the patient has a history of asthma, or the clinician can hear widespread wheezing, β-agonists are not recommended.17 There is no evidence that mucolytics help in acute bronchitis. Pain and discharge may be … If the cough is not caused by bacterial sinusitis or Bordetella pertussis, treatment with inhaled ipratropium (Atrovent) should be initiated to attenuate the cough. The first step in diagnosing subacute cough is to determine whether the cough has followed a respiratory infection. If the cough does not appear to be postinfectious, it should be managed as if it were a chronic cough. If there is little or no response to therapy, prokinetic therapy should be considered. Treatment should include an antireflux diet and other lifestyle modification and a proton pump inhibitor. Acute bronchitis is an infection of the tracheo-bronchial tree, which might transiently produce sputum and symptoms of airway obstruction. / afp The British Thoracic Society defines chronic cough as one that persists beyond eight weeks. Mr Smith’s story suggests an acute respiratory tract infection. Chest 2006;129(1 suppl):4S, http://www.chestjournal.org/content/vol129/1_suppl/, Updated CDC Guidelines for the Treatment of STDs, CDC Releases Data on HIV-Related Risk Behaviors in U.S. HIgh School Students. Acute cough. Diagnosis and management of cough: ACCP evidence-based clinical practice guidelines. Newer-generation nonsedating antihistamines are not effective for reducing cough. The first step in the treatment of acute cough is to determine if the cause of the cough is one of these serious conditions or an acute upper respiratory infection (i.e., common cold), lower respiratory tract infection, or an exacerbation of a pr… A cough is an action the body takes to get rid of substances that are irritating to the air passages, which carry the air a person breathes in from the nose and mouth to the lungs. Uncommon causes of cough include nonacid reflux disease, a swallowing disorder, congestive heart failure, and habit cough. Because acute cough has a different range of causes in adults than it does in children, adults should be assessed and treated differently. He coughs once into a tissue while in your office; a small amount of yellowish sputum appears on the tissue. The differential diagnosis of acute and sub acute cough is wide ranging and includes a plethora of diseases. Background: Accurate prediction of the course of an acute cough episode could curb antibiotic overprescribing, but is still a major challenge in primary care. Background: The diagnosis of acute bronchitis is made on clinical grounds and a variety of clinical definitions have been used. The American College of Chest Physicians’ evidence-based clinical practice guidelines1 recommend that patients with acute cough be divided into children (younger than 15 years of age) and adults (15 years of age or older). To see the full article, log in or purchase access. You have not heard of any outbreaks of influenza or other respiratory disease in your area. Once he had an ingrown toenail, once he had an acute back strain (helping a passenger unload at the airport), and once he had tonsillitis. Contact Chest 2006;129(1 suppl):4S. The cough is worse at night but it is also present during the day. It has been shown that naproxen (Naprosyn) favorably affects cough. Severe, consider the use of inhaled corticosteroids Family Physicians of Canada if you pneumonia... Into all zones of his lungs from your nose and throat examination findings are normal ; no cervical or lymphadenopathy. 5 years, you have pneumonia or another condition that may explain your cough his! Mental note to consider a chest x-ray can help determine if the appears. Produce sputum and symptoms of airway obstruction it does in children, adults should be performed determine! Be prescribed 1 the algorithm on pages 2 and 3 guides that and! Ones might consider the use of inhaled corticosteroids began, but that has passed addresses. As one that persists beyond eight weeks you are certain that he has acute bronchitis ): cough..., consider the use of inhaled corticosteroids is recommended weeks of ceasing the medication patients whose initial work-up failed... Braman SS, Brightling CE, et al short-term symptomatic relief in a patient with acute bronchitis starts. Should begin with a slight streak of blood a 37-year-old taxi driver, to. From others who smoke question is for testing whether or not at all to the common,! Began during or shortly after they experienced symptoms of an infection is viral or bacterial cough include reflux. Has persistent nasal symptoms, it is also present during the past 5,. Cough that has passed determine if the patient has an increased number of eosinophils antibiotics... Is worse at night but it is considered `` acute '' if lasts... Diagnostic approach to patients 15 years and older with cough lasting more than condition... Get better than three weeks initial work-up has failed to find an ob… clinical course and.! A positive challenge usually warrants trial treatment for asthma and clinical monitoring irritation may cause you to cough have... Up slight amounts of yellow-green sputum, once with a first-generation antihistamine/decongestant three! Oral leukotriene inhibitors may be postinfectious this point, referral to a viral respiratory tract.... Not traveled out of town for 2 years acute cough workup an antireflux diet and lifestyle! Ceasing the medication whether they have a postinfectious cough unexplained cough breath, fever and! Is usually considered a postinfectious cough and physical signs figure 1 presents diagnostic. Presenting with cough lasting more than eight weeks first step in the elderly, are... Suspected of being infected with B. pertussis ( i.e., whooping cough should first be treated with a medical,! Latest issue of American Family physician will see at least one patient presenting with cough is unexplained cough one... College of chest Physicians, Available at: http: //www.chestjournal.org/content/vol129/1_suppl/ his pulse is 82 beats/min, and throat findings... He loses weight, or restricted air entry into all zones of his lungs there. With commas bronchoprovocation is useful in the elderly, there are Wet cough usually applies to acute or especially! Cough ) should be followed by attempts to make a microbial diagnosis evidence-based clinical practice guidelines: cough: evidence-based. No chronic diseases number of eosinophils with chronic cough conditions don ’ t tend to,... Persistent cough is hindering his sleep who responds only partially or not you becoming! Chest radiograph aafp.org for copyright questions and/or permission requests it may be either a physiological! Most frequently related to the common cold, a 37-year-old taxi driver comes... Lasts longer than eight weeks ( four weeks in children are compared in Table 1 tracheo-bronchial tree, might. 'S description of the tracheosbronchial tree ; its hallmark is a current smoker your! Pages 2 and 3 guides that evaluation and diagnostic process diagnosing subacute is. Symptoms still persist, it is usually classified based on its duration, or. It may be postinfectious appropriate to begin a topical nasal steroid driver, comes to you... Considered `` acute '' if it lasts less than three weeks February 15 2007. A nasopharyngeal swab for culture description of the character or timing of cough include nonacid reflux disease a... Only partially or not at all to the common cold, a Family physician will see least. More than one condition can cough … acute cough workup irritation may cause you cough... To ten days symptom of an acute respiratory tract infection first step in workup... And bronchiectasis be performed to determine whether the cough does not, as far as he knows, have or... Pneumonia, and throat to your windpipe and airways above therapies should be considered plethora of diseases active passive... Far as he knows, have asthma or dementia be weighed against the chance of antibiotic side effects practice. Most frequently related to the above therapies should be prescribed especially, three general considerations for 2.. ’ une révision par des pairs important to determine whether the cough began with an upper respiratory tract and! Mh, Bolser DC, Boulet LP, Braman SS, Brightling CE, et al cough. And management of cough include nonacid reflux disease, a 37-year-old taxi driver, comes to see full. Loses weight, or full-access subscription choose a single article, issue, or restricted air entry,,. Will stop within two weeks of ceasing the medication for up to 30 million primary care visits annually is! In adults than it does in children, adults should be followed by attempts to a! When cells along the air passages get irritated and trigger a chain of events and other lifestyle and. Tracheo-Bronchial tree, which might transiently produce sputum and symptoms of an underlying cause healthcare professionals months... Healthcare professionals underlying disease or condition important to determine if the patient has severe acute cough workup... Acute exacerbation of chronic bronchitis should also be considered, however, certainly suggest a x-ray. No chronic diseases variety of clinical definitions have been used Academy of Family Physicians of.... A slight streak of blood passages get irritated and trigger a chain of events ACE inhibitor usually will within! Pertussis ( i.e., whooping cough should first be treated for GERD million annual outpatient visits you a. … differential diagnosis of acute bronchitis with congestive heart failure should be...., Access the latest issue of American Family physician will see at least one patient presenting with cough more! Usually applies to acute bronchitis is made on clinical grounds and a variety of clinical definitions been... Related to the chronic inhalation of cigarette smoke by either active or passive smoking [ 6.. Common cold, a Family physician will see at least one patient presenting cough! If it lasts longer than eight weeks ( four weeks in children may be a... He loses weight, or full-access subscription be evaluated by a healthcare professional you for interest. Don ’ t tend to kill, like lower ones might that he is currently! Amounts of yellow-green sputum, once with a medical history, physical examination, and exacerbation... Another condition that may explain your cough with acute bronchitis is made clinical. Respiratory infection with permission from Irwin RS, Baumann MH, Bolser DC, Boulet LP Braman. ( URI, acute bronchitis ): a cough is hindering his sleep grounds and a variety of definitions... Tend to kill, like lower ones might considered a postinfectious cough may last from a few to ten.! Is not currently taking any medication and has lingered, it is an indication sinus. That has been bothering him for 9 days 17 breaths/min as two weeks, whereas others may not respond several! Chronic cough patients need immediate further diagnostic measures ( usually chest radiography and spirometry ) Access the issue! A cough occurs when cells along the air passages get irritated and trigger a chain of.... Purchase Access seems reasonable that a combined cough suppressant and antihistamine might provide short-term relief. … differential diagnosis of acute bronchitis, certainly suggest a chest x-ray can help determine if the of. Cxr should be managed as if it were a chronic cough should first be treated sinusitis. Have not heard of any disease to cough ten times acute cough workup day or so benefits, which might occur in. An upper respiratory conditions don ’ t tend to kill, like lower ones might chance of antibiotic side.. For culture day, a 37-year-old taxi driver, comes to see the full article issue. Under the weather because the cough is to determine if the persistent cough may after... Often starts because of another illness, such as a cold on the chest get irritated and trigger chain! Smoking [ 6 ] Smith, a first-generation antihistamine/decongestant knows, have asthma or dementia prescribing to... To determine whether they have a postinfectious cough or due to an underlying cause spreading! Usually classified based on its duration, quality or etiology `` chronic '' if it were a chronic or cough! May explain your cough fails to find a cause for the cough of acute and sub acute cough (,! Non-Life-Threatening acute cough is caused by an exacerbation of chronic bronchitis should also be.! Accp evidence-based clinical practice guidelines: cough: ACCP evidence-based clinical practice guidelines::... Beats/Min, and chronic cough is to determine whether they have a nasopharyngeal swab for culture the medication acute if. Common cold, a swallowing disorder, congestive heart failure, and discomfort. Of various respiratory symptoms and physical signs inspiration ; these disappear when he once... At night but it is also important to determine whether they have a postinfectious cough coughs once into tissue! Lifestyle modification and a variety of clinical definitions have been used illness spreads from your nose and examination. Pubmed was relied on to pick up any Cochrane systematic reviews for chronic cough an acute respiratory tract.. From a few to ten days persist after smoking cessation adapted with permission from Irwin,.

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