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KEY CONCEPTS
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Cough is classified as acute, subacute, or chronic based on duration of symptoms.
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Cough is an essential component for lung health maintenance, but persistent or excessive cough ceases to be protective, is bothersome, and adversely affects quality of life.
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Although cough is associated with a variety of diseases, the duration of cough helps narrow the potential etiologies for cough symptoms.
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The presence of dyspnea, red flag symptoms, and/or symptoms suggestive of acute bacterial rhinosinusitis indicates the need for referral to the patient’s primary care physician.
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Treatment trials (eg, intranasal corticosteroids, first-generation antihistamines, treatments for gastroesophageal reflux disease) can help rule out common causes of chronic cough.
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Patient Care Process for Cough
Collect
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Duration of symptoms, red flag symptoms (see Table e12-5), and the presence and severity of symptoms associated with acute bacterial rhinosinusitis (see Tables e12-6 and e12-7)
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Use validated symptom questionnaires as needed (see text).
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Current medical conditions, family history, and occupational and environmental (eg, pets, carpet/bedding, mold) history
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Tobacco and marijuana use, prior allergies, and immunization history and medications
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Ability to access medications and adherence to current medications
Assess
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Indicators of acute, subacute, or chronic cough (see Table e12-1 and text)
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Red flag symptoms (see Table e12-5) or symptoms associated with acute bacterial rhinosinusitis (see Tables e12-6 and e12-7) indicating need for referral to primary care provider
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Active medical problems associated with chronic cough (see Table e12-2)
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Possibility of cough related to gastroesophageal reflux disease (GERD; see Chapter 49, “Gastroesophageal Reflux Disease”)
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If applicable, estimate creatinine clearance to assess dosing of current or new medications.
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If the patient taking any medications associated with cough (especially ACE inhibitors; see Table e12-4)
Plan*
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Refer to primary care provider for assessment of cough with dyspnea, red flag symptoms (see Table e12-5), or symptoms related to environmental or occupational exposures.
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Smoking cessation interventions in those ready to quit smoking (see Chapter 82, “Substance-Related Disorders II: Alcohol, Nicotine, and Caffeine”)
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Immunizations if not contraindicated (eg, influenza, pneumococcal, diphtheria, tetanus, acellular pertussis; see Chapter 142, “Vaccines and Immunoglobulins”)
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Step-up therapy in patients with asthma-related cough to improve symptom control (see Chapter 43, “Asthma”)
Implement*
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Patient education
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Recommendations that are within scope of practice
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Document in health record
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Instructions and schedule for follow-up
Follow-up: Monitor and Evaluate
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Reevaluate in 4 to 6 weeks and reassess using validated symptom questionnaires as needed.
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Adherence to care plan
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Adverse drug effects
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Immunizations for those deferred earlier (see Chapter 142)
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For acute or subacute cough that persists for more than 8 weeks (ie, progresses to chronic cough), trial of an oral first-generation antihistamine and/or intranasal corticosteroid
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For chronic cough that does not improve with an oral first-generation antihistamine and an intranasal corticosteroid, refer patient to primary care provider for ruling out asthma and nonasthmatic eosinophilic bronchitis before recommending treatment trial for GERD.
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