Cough

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:

Differential Diagnosis

Cough

Acute (< 3 wks)

Chronic (> 8 wks)

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

Disposition

  • Admit:
  • 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

External Links

References

  1. ↑ Oduwole O, et al. Honey for acute cough in children. Cochrane Database Syst Rev. 2018;4:CD007094.
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