Cough

Adults

Infectious

Non-infectious

  • Acute cough

  • Chronic cough (duration ≥ 8 weeks)

    • Upper airway cough syndrome (post-nasal drip): Rhinorrhea, congestion, swollen turbinates, posterior pharyngeal cobblestoning

      • Allergic rhinitis: Start mometasone 50 mcg/spray BID +/- loratadine 10 mg daily and follow-up in 4 weeks

      • Non-allergic rhinitis: Start intranasal ipratropium bromide (0.03% solution) two sprays in each nostril BID and follow-up in 4 weeks

      • If no improvement at follow-up: Consider alternate etiology and treat accordingly. If concern for chronic rhinosinusitis, schedule sinus CT. Otherwise, refer to ENT for flexible sigmoidoscopy.

    • Asthma-induced cough

    • Non-asthmatic eosinophilic bronchitis

    • GERD-induced cough

    • ACE-inhibitor induced

    • Tobacco use

    • Less common etiologies: Pertussis, OSA, COPD, bronchiectasis, sarcoidosis

Hemoptysis

Etiologies

Initial workup: Obtain CXR

  • CXR shows infiltrate: Diagnose pneumonia and start azithromycin 500 mg on day 1 followed by 250 mg on days 2 through 5

  • Negative CXR

    • Low risk patient: No further treatment

    • High risk patient, i.e. age ≥ 40 years or ≥ 30 pack year smoking history: Obtain CT

      • Positive CT: Treatment per pathology

      • Negative CT: Consult pulmonology and consider bronchoscopy

Pediatrics