Acute and Chronic Cough

Acute Cough

40 y/o patient with h/o asthma, COPD, and workplace exposure to lung irritants presents with cough symptoms lasting < 3 weeks. Reports recent upper respiratory illness. Non-productive cough on exam.

  • Symptom management by age

    • > 1 y/o: Administer 1 teaspoon honey q6h PRN

    • > 4 y/o: Consider dextromethorphan for cough suppression

    • > 12 y/o and not pregnant: Consider decongestants (e.g. pseudoephedrine) for relief of nasal congestion

  • Counseling

    • Pt advised that cough is likely related to recent viral illness

    • Pt advised to avoid occupational/environmental exposure

    • Pt advised to follow-up if cough persists for >8 weeks

Additional risk factors

  • Endorses dyspnea: Consider workup for heart failure and/or obstructive airway disease

  • Reports hemoptysis

    • Obtain CXR

    • Age 40+ years with 30+ pack/year smoking history

      • CXR negative for pathology: Obtain CT

      • CT negative with persistent hemoptysis: Refer to pulmonology for evaluation +/- bronchoscopy

Chronic Cough

Pt with h/o smoking, COPD, HTN, upper airway cough syndrome, GERD, asthma, non-asthmatic eosinophilic bronchitis presents with cough x8 weeks. Reports vomiting, chest pain, brief syncopal episode, and difficulty sleeping. Denies fever, weight loss, hemoptysis, hoarseness, excessive dyspnea or sputum production, recurrent pneumonia. Non-productive cough on exam; LCTAB.

  • Obtain CXR to r/o infectious/inflammatory/malignant conditions; if negative, initiate empiric treatment

  • Concern for asthma-induced cough; refer for spirometry

  • STOP-BANG >= 5; refer for sleep study

  • Switch ACE to ARB

  • Optimize COPD treatment

  • Pt advised to avoid cigarette smoke, other airborne irritants

  • Consider gabapentin or pregabalin for persistent symptoms

  • Consider CT and/or referral to pulmonology if cough etiology is not identified and initial tx not effective

Notes

  • Common etiologies

    • Upper airway cough syndrome (post-nasal drip)

    • Asthma-induced cough

    • GERD-induced cough

    • ACE-inhibitor induced

  • Less common etiologies

    • OSA

    • COPD

    • Sarcoidosis