Cough: Difference between revisions
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== | ==Background== | ||
*Cough is a common chief complaint in the ED | |||
*Can be classified by duration: | |||
**'''Acute:''' <3 weeks — most commonly viral [[URI]], but must consider life-threatening causes | |||
**Subacute: 3-8 weeks — often post-infectious | |||
**Chronic: >8 weeks — consider asthma, GERD, post-nasal drip, ACE inhibitors | |||
*The primary ED goal is to identify and treat '''emergent causes''' (PE, pneumothorax, foreign body, anaphylaxis, acute heart failure) and risk-stratify for serious infection | |||
== | ==Clinical Features== | ||
*Key history elements: | |||
**Duration, productive vs dry, hemoptysis, fever, dyspnea, chest pain, weight loss | |||
**Medication history (particularly [[ACE inhibitor|ACE inhibitors]]) | |||
**Smoking status, occupational/environmental exposures | |||
**Immunocompromised status | |||
*Red flags: | |||
**[[Hemoptysis]] | |||
**Acute [[dyspnea]] or hypoxia | |||
**[[Chest pain]] with cough (consider [[PE]], [[pneumothorax]]) | |||
**Stridor or respiratory distress | |||
**[[Fever]] with toxic appearance | |||
**Immunocompromised patient with new cough | |||
[[Category: | ==Differential Diagnosis== | ||
{{Cough DDX}} | |||
==Evaluation== | |||
*Pulse oximetry on all patients | |||
*[[CXR]] if: | |||
**Fever, dyspnea, hypoxia, hemoptysis, or abnormal lung exam | |||
**Immunocompromised | |||
**Concern for [[pneumonia]], [[CHF]], [[pneumothorax]], or [[malignancy]] | |||
**Persistent cough >3 weeks without clear cause | |||
*Additional workup as indicated: | |||
**[[ECG]] if cardiac cause suspected | |||
**[[CT-PA]] if concern for [[PE]] | |||
**[[BNP]]/NT-proBNP if concern for [[CHF]] | |||
**CBC, blood cultures if sepsis or severe pneumonia suspected | |||
**[[Pertussis]] testing if clinical suspicion (paroxysmal cough, post-tussive emesis, inspiratory whoop) | |||
==Management== | |||
*Treat underlying cause | |||
*Viral [[URI]]: Supportive care; honey (>1 year old) has modest evidence for symptom relief<ref>Oduwole O, et al. Honey for acute cough in children. Cochrane Database Syst Rev. 2018;4:CD007094.</ref> | |||
*[[Pneumonia]]: Antibiotics per local guidelines (see [[Pneumonia (main)]]) | |||
*[[Asthma]]/reactive airway: [[Albuterol]] nebulizer, consider steroids | |||
*[[CHF]]: Diuresis, [[nitroglycerin]] (see [[Congestive heart failure]]) | |||
*[[PE]]: Anticoagulation (see [[Pulmonary embolism]]) | |||
*OTC cough suppressants (dextromethorphan, codeine): Limited evidence of efficacy; avoid codeine in children <12 years | |||
*Benzonatate: 100-200 mg PO TID; can cause toxicity if chewed | |||
==Disposition== | |||
*Admit: | |||
**[[Pneumonia]] with sepsis, hypoxia, or significant comorbidities | |||
**[[PE]], [[pneumothorax]], [[CHF]] exacerbation | |||
**Massive [[hemoptysis]] | |||
*Discharge with follow-up: | |||
**Uncomplicated [[URI]]/acute bronchitis | |||
**Stable [[pneumonia]] meeting outpatient criteria | |||
**Provide return precautions: worsening dyspnea, hemoptysis, high fever, inability to tolerate PO | |||
==See Also== | |||
*[[Hemoptysis]] | |||
*[[Pneumonia (main)]] | |||
*[[Acute asthma exacerbation]] | |||
*[[Bronchitis]] | |||
*[[Pertussis]] | |||
*[[Croup]] | |||
==External Links== | |||
==References== | |||
<references/> | |||
[[Category:Pulmonary]] | |||
[[Category:Symptoms]] | |||
Latest revision as of 09:28, 22 March 2026
Background
- Cough is a common chief complaint in the ED
- Can be classified by duration:
- Acute: <3 weeks — most commonly viral URI, but must consider life-threatening causes
- Subacute: 3-8 weeks — often post-infectious
- Chronic: >8 weeks — consider asthma, GERD, post-nasal drip, ACE inhibitors
- The primary ED goal is to identify and treat emergent causes (PE, pneumothorax, foreign body, anaphylaxis, acute heart failure) and risk-stratify for serious infection
Clinical Features
- Key history elements:
- Duration, productive vs dry, hemoptysis, fever, dyspnea, chest pain, weight loss
- Medication history (particularly ACE inhibitors)
- Smoking status, occupational/environmental exposures
- Immunocompromised status
- Red flags:
- Hemoptysis
- Acute dyspnea or hypoxia
- Chest pain with cough (consider PE, pneumothorax)
- Stridor or respiratory distress
- Fever with toxic appearance
- Immunocompromised patient with new cough
Differential Diagnosis
Cough
Acute (< 3 wks)
- URI (rhinitis, sinusitis, pertussis)
- LRI (bronchitis, pneumonia)
- Influenza
- Allergy
- Asthma
- Environmental irritants
- Transient airway hyperresponsiveness
- Foreign body
- SARS
Chronic (> 8 wks)
- Postinfectious; pertussis
- Smoking and/or chronic bronchitis
- Postnasal discharge
- Asthma
- GERD
- ACEI/ARB
- CHF
- Lung cancer or intrathoracic mass
- Emphysema
- Interstitial lung disease
- Psychiatric
Evaluation
- Pulse oximetry on all patients
- CXR if:
- Fever, dyspnea, hypoxia, hemoptysis, or abnormal lung exam
- Immunocompromised
- Concern for pneumonia, CHF, pneumothorax, or malignancy
- Persistent cough >3 weeks without clear cause
- Additional workup as indicated:
Management
- Treat underlying cause
- Viral URI: Supportive care; honey (>1 year old) has modest evidence for symptom relief[1]
- Pneumonia: Antibiotics per local guidelines (see Pneumonia (main))
- Asthma/reactive airway: Albuterol nebulizer, consider steroids
- CHF: Diuresis, nitroglycerin (see Congestive heart failure)
- PE: Anticoagulation (see Pulmonary embolism)
- OTC cough suppressants (dextromethorphan, codeine): Limited evidence of efficacy; avoid codeine in children <12 years
- Benzonatate: 100-200 mg PO TID; can cause toxicity if chewed
Disposition
- Admit:
- Pneumonia with sepsis, hypoxia, or significant comorbidities
- PE, pneumothorax, CHF exacerbation
- Massive hemoptysis
- Discharge with follow-up:
See Also
External Links
References
- ↑ Oduwole O, et al. Honey for acute cough in children. Cochrane Database Syst Rev. 2018;4:CD007094.