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==Treatment==
==Treatment==
Shown below is an algorithm summarizing the treatment of [[Cough]] according to the [[American College of Chest Physicians]] guidelines.
Shown below is an algorithm summarizing the treatment of [[Cough]] according to the [[American College of Chest Physicians]] guidelines.
{{familytree/start |summary=Sample 11}}{{familytree/start |summary=PE diagnosis Algorithm.}}
 
{{familytree/start |summary=Sample 12}}{{familytree/start |summary=PE diagnosis Algorithm.}}
{{Family tree/start}}
{{Family tree/start}}
{{familytree  |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | B01 | | | | | B01=<div style="float: left; text-align: left; height: 10em; width: 17em; padding:1em;"> '''Acute Cough:'''<br>
{{Family tree/start}}
----
{{Family tree | | | | A01 | | | |A01= [[File:Cough image.jpg|300px]]}}
❑ determine if the cause of the cough is one of these serious conditions and treat accordingly <br> ❑ Cough due to the common cold: a first-generation antihistamine plus a decongestant <br> ❑ *naproxen (Naprosyn) favorably affects cough <br> ❑ *Newer-generation nonsedating antihistamines are not effective  <br> </div>}}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | B01 | | | |B01= '''Acute Cough'''}}
{{Family tree | |,|-|-|^|-|-|.| | }}
{{Family tree | C01 | | | | C02 |C01= determine if the cause of the cough is one of these serious conditions and treat accordingly| C02= Cough due to the common cold: a first-generation antihistamine plus a decongestant<br> ❑ naproxen (Naprosyn) favorably affects cough <br> ❑ Newer-generation nonsedating antihistamines are not effective  <br> </div>}}
{{familytree/end}}
{{familytree/end}}
<br>
<br>
{{familytree/start |summary=Sample 11}}{{familytree/start |summary=PE diagnosis Algorithm.}}
 
{{familytree/start |summary=Sample 12}}{{familytree/start |summary=PE diagnosis Algorithm.}}
{{Family tree/start}}
{{Family tree/start}}
{{familytree  |boxstyle=background: #FFFF00; color: #F8F8FF;| | | | | B01 | | | | | B01=<div style="float: left; text-align: left; height: 10em; width: 17em; padding:1em;"> '''<span style="color:navy;">The items:</span>'''<br>
{{Family tree/start}}
----
{{Family tree | | | | A01 | | | |A01= [[File:Pertussis.jpg|300px]]}}
<span style="color:navy;">❑</span> <span style="color:navy;">a</span> <br> <span style="color:navy;">❑</span> <span style="color:navy;">b</span> <br><span style="color:navy;">❑</span> <span style="color:navy;">c</span>  <br><span style="color:navy;">❑</span> <span style="color:navy;">d</span> <br> <span style="color:navy;">❑</span> <span style="color:navy;">e</span> </div>}}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | B01 | | | |B01= Box 2 in Row 2}}
{{Family tree | |,|-|-|^|-|-|.| | }}
{{Family tree | C01 | | | | C02 |C01= Box 3 in Row 3| C02= Box 4 in Row 4}}
{{familytree/end}}
{{familytree/end}}




Revision as of 02:00, 27 October 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Haddadi, M.D.[2]

Cough
Resident Survival Guide
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

Causes

Common Causes

Diagnosis

Shown below is an algorithm summarizing the evaluation of acute cough according to the American College of Chest Physicians guidelines.[1]

 
 
 
 
 
 
 
 
Acute Cough
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
History and physical

examination, ask about environmental and occupational factors and travel exposures

± investigations
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Life-threatening diagnosis
 
 
 
 
 
 
 
 
 
 
 
Non-life-threatening diagnosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pneumonia, severe

exacerbation of asthma or COPD, PE, heart failure, other serious

disease
 
 
 
 
 
Infections
 
 
 
 
 
 
 
 
 
Exacerbation of pre-existing condition
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
LRTI
 
 
URTI
 
 
 
Asthma
 
Bronchiectasis
 
UACS
 
COPD
 
Evaluate and treat first
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute Bronchitis
 
 
 
Pertussis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider TB in

endemic areas

or high risk
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Subacute Cough
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
History and Physical Exam Ask about red flags,

environmental and occupational factors,

travel exposures
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Postinfectious or life-threatening diagnosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
New onset or exacerbation of pre-existing condition
 
 
 
 
Not postinfectious*
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pneumonia, severe exacerbation of asthma or COPD, PE, heart failure, other serious disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pertusis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
COPD
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
UACS
 
Asthma
 
Bronchitis
 
GERD
 
Bronchiectasis
 
 
 
 
 
 
 
 
 
 
{{{ }}}
 
 
 
 
Postinfectious
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
TB
 
 
 
 
 
 
 
NAEB
 
 
 
AECB/COPD
 
 
 
 
 
  • Not postinfectious: Work up same as chronic cough


 
 
 
 
 
 
 
 
Chronic Cough
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
History, Physical exam and CXR
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Life-threatening condition
 
 
 
 
Consider 4 most common causes: 1)Upper Airway Cough Syndrome (UACS), secondary to rhinosinus diseases, 2)Asthma, 3)Non-asthmatic Eosinophilic Bronchitis 4)Gastroesophageal Reflux Disease (GERD)
 
 
 
 
Smoking, ACEI, Sitagliptin
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treat based on the cause
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Discontinue for at least 4week
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Follow up 4-6 weeks if inadequate response
 
Initial treatments for each condition
 
 
 
 
Further investigation if No response to treatment*
 
Consider 4 most common causes of cough if No response at4-6 week follow up
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Follow up 4-6 weeks if inadequate response to optimal treatment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Consider the following further investigations if no response to treatment*:

  • 24h esophageal pH / Impedance monitoring
  • Endoscopic and/or videofluoroscopic swallow evaluation
  • Barium esophagram / Modified barium swallow
  • Sinus Imaging• HRCT
  • Bronchoscopy• Cardiac Work-up (ECG, Holter Monitoring, Echo)
  • Environmental / Occupational Assessment
  • Consider uncommon causes

Treatment

Shown below is an algorithm summarizing the treatment of Cough according to the American College of Chest Physicians guidelines.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute Cough
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
determine if the cause of the cough is one of these serious conditions and treat accordingly
 
 
 
Cough due to the common cold: a first-generation antihistamine plus a decongestant
❑ naproxen (Naprosyn) favorably affects cough
❑ Newer-generation nonsedating antihistamines are not effective


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Box 2 in Row 2
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Box 3 in Row 3
 
 
 
Box 4 in Row 4


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

  • The content in this section is in bullet points.

Don'ts

  • The content in this section is in bullet points.

References

  1. ↑ Irwin RS, French CL, Chang AB, Altman KW, CHEST Expert Cough Panel* (2018). "Classification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report". Chest. 153 (1): 196–209. doi:10.1016/j.chest.2017.10.016. PMC 6689094 Check |pmc= value (help). PMID 29080708.
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