Cough resident survival guide

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

• Allergic Rhinitis
• Asthma
• Bronchiectasis
• Gastroesophageal Reflux Disease (GERD)
• Post-nasal drip
• Medications' side effect
  • ACE inhibitors
• Bronchitis
• Laryngopharyngeal reflux
• Respiratory tract infection
• Lung cancer
• Nonasthmatic eosinophilic bronchitis

Diagnosis

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

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

• Shown below is an alogrithm describing the evaluation of subacute cough in adults according to the American College of Chest Physicians guidelines.

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

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Postinfectious

TB

NAEB

AECB/COPD

• Not postinfectious: Work up same as chronic cough

• Shown below is an algorithm describing the evaluation of chronic cough in adults according to the American College of Chest Physicians guidelines.

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

The items: ❑ a ❑ b ❑ c ❑ d ❑ e

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References