Cough

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Cough is the forceful expulsion of air from the lungs that helps clear secretions, foreign bodies, and irritants from the airway.

Acute cough (less than 3 weeks)                      

Non-life threatening

Life-threatening

-        Upper respiratory tract infections (URIs)

-        Acute bronchitis

-        Laryngo-tracheo-bronchitis (“croup”) in children

-        Acute heart failure

-        Acute pulmonary embolism

-        Severe Pneumonia

-        Acute exacerbation of bronchial asthma

-        Acute exacerbation of COPD

-        Acute inhalation injury 

Subacute cough (3-8 weeks)

  • Post-infectious cough
  • Bacterial sinusitis
  • Pneumonia
  • Acute exacerbation of chronic bronchitis
  • Bronchial asthma

Chronic cough >8 weeks in adults and >4 weeks in children

  • Bronchial asthma/cough variant asthma
  • Gastroesophageal reflux disease (GERD)
  • Upper airway cough syndrome previously known as postnasal drip syndrome
  • Allergic fungal sinusitis
  • Allergic rhinitis
  • Non-allergic rhinitis (due to medicines, post-infection, chemical or physical irritants)
  • ACE-inhibitor induced cough
  • Pertussis
Productive (phlegm or mucous)
Non-productive
Nocturnal cough
Seasonal
Red flag symptoms (indicate further investigations)

-    Pneumonia

-    Bronchitis

-    Tuberculosis

-    Bronchial asthma

-    Viral pneumonia

-    Bronchial asthma

-    GERD

-    Heart failure

-    Bronchial asthma

-    Allergic rhinitis

-    Allergic sinusitis

-    Fever

-    Haemoptysis

-     Weight loss

-    Severe respiratory distress

 

Investigations

  • History taking and physical examination are sufficient to diagnose the cause of an acute cough
  • Blood culture for suspected pneumonia
  • Tuberculin skin test for patients with suspected TB
  • Chest radiograph for suspected pulmonary infection
  • Sputum examination for acid-fast bacilli for suspected TB
  • Sputum culture for suspected TB or bacterial pneumonia
  • Complete blood count for patients with chronic cough and red-flag symptoms
    • Neutrophilic leucocytosis in suspected TB or allergy
    • Eosinophilia in suspected bronchial asthma
    • Gene xpert
Non-pharmacologic treatment

Non-life-threatening acute cough:

  • Honey 
  • Menthol
  • Hydration
  • Lozenges
  • Humidifiers

Chronic cough

  • Stop precipitating factors
  • Stop or substitute ACE inhibitors
Pharmacologic treatment
  • Analgesics for fever, head and body aches
  • Antibiotics are usually not recommended for non-life-threatening acute cough.
  • Give antibiotics only to persons suspected to have bacterial infections
  • Treat the underlying cause (see sections on congestive heart failure, bronchial asthma, COPD, croup, pertussis,)
  • GERD (PPIs for 8-12 weeks)
  • Empirical cough management

Cough

Productive Cough (Expectorants)

Diphenhydramine oral

25-50 mg every 4 hours when necessary (syrup preferred); not to exceed 150 mg/day

Non-productive cough

Cough suppressant

Antitussives

Useful for dry, irritating cough or cough that serves no useful purpose such as clearing excessive sputum production or secretions

Dextromethorphan (abuse potential less than codeine) oral

Liquid and syrup: 10-20 mg every 4 hours or 30 mg every 6-8 hours

Gel: 30 mg every 6-8 hours; not to exceed 120 mg/24 hours

Codeine oral

7.5-30 mg every 4-6 hours when necessary

Post-infectious cough

  • No treatment may be required, as it often resolves spontaneously

If cough is interfering with sleep, give antitussives, oral or inhaled corticosteroids or bronchodilators according to aetiology