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KEY CONCEPTS
Cough is classified as acute, subacute, or chronic based on duration of symptoms.
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.
Although cough is associated with a variety of diseases, the duration of cough helps narrow the potential etiologies for cough symptoms.
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.
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
Duration of symptoms, red flag symptoms (see Table e13-5), and the presence and severity of symptoms associated with acute bacterial rhinosinusitis (see Tables e12-6 and e12-7)
Use validated symptom questionnaires as needed (see text).
Current medical conditions, family history, and occupational and environmental (eg, pets, carpet/bedding, mold) history
Tobacco and marijuana use, prior allergies, and immunization history and medications
Ability to access medications and adherence to current medications
Assess
Indicators of acute, subacute, or chronic cough (see Table e13-1 and text)
Red flag symptoms (see Table e13-5) or symptoms associated with acute bacterial rhinosinusitis (see Tables e12-6 and e12-7) indicating need for referral to primary care provider
Active medical problems associated with chronic cough (see Table e13-2)
Possibility of cough related to gastroesophageal reflux disease (GERD; see Chapter 50, “Gastroesophageal Reflux Disease”)
If applicable, estimate creatinine clearance to assess dosing of current or new medications.
If the patient taking any medications associated with cough (especially ACE inhibitors; see Table e13-4)
Plan*
Refer to primary care provider for assessment of cough with dyspnea, red flag symptoms (see Table e13-5), or symptoms related to environmental or occupational exposures.
Smoking cessation interventions in those ready to quit smoking (see Chapter 85, “Substance Use Disorders I: Opioids, Cannabis, and Stimulants”)
Immunizations if not contraindicated (eg, influenza, pneumococcal, diphtheria, tetanus, acellular pertussis; see Chapter 147, “Vaccines, Toxoids, and Other Immunobiologics”)
Step-up therapy in patients with asthma-related cough to improve symptom control (see Chapter 44, “Asthma”)
Implement*
Patient education
Recommendations that are within scope of practice
Document in health record
Instructions and schedule for follow-up
Follow-up: Monitor and Evaluate
Reevaluate in 4 to 6 weeks and reassess using validated symptom questionnaires as needed.
Adherence to care plan
Adverse drug effects
Immunizations for those deferred earlier (see Chapter 147)
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
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 ...