Acute Cough

Differential Diagnosis

Upper Respiratory Tract Common Cold  (URI) Allergic Rhinitis Sinusitis Laryngo-Tracheitis (“Croup”) Foreign Body Aspiration

Lower Respiratory Tract Influenza (& other viruses) Asthma / COPD Exacerbation Acute Bronchitis Pneumonia Congestive Heart Failure Pertussis

SUMMARY APPROACH for ACUTE COUGH

Any degree Resp. Distress — Must get CXR

The following guide is for well-appearing pts, normal resp. rate & O2Sat

 

Cough  —  NO Fever  and  NORMAL Lung Exam

Prominent Nasal Sx  —  Consider:

• URI — default Dx (Sx <2 wks)
• Allergic Rhinitis  —  any of below
  • Sneezing / Itchy Eyes
  • Prior Recurrent Episodes
  • PE:  Pale Mucosa, Allergic Shiners/Salute
• Sinusitis (uncommon)
  • Initial Sx resolving, & suddenly worsen

No Nasal Sx

• Tracheitis  (probably)
• Pertussis  (consider)

Cough  PLUS  Fever

Influenza Season  (late Nov – April)

Day #1-3:  Dx Influenza.  No CXR unless:

• Rales
• Significant Dyspnea or Pleuritic CP
• Compromised Host

Day #4-5 & later:  Get CXR (r/o Pneumonia) if:

• Not beginning to get better
• Getting better, then abruptly worse

Not Influenza Season

Same as above, except:

• Dx Viral Syndrome
• Lower threshold for CXR to r/o Pneumonia
  • Purulent Sputum without Nasal Sx
  • Very abrupt onset plus Pleuritic CP

Cough  PLUS Abnormal  Lung Sounds  (NO fever)

** Rales:  Get CXR

• Bibasilar Rales suggest CHF
• New Focal Rales:  See what’s there

** Wheezes = Bronchospasm

• Dx Bronchitis if no prior Hx
• Dx Asthma if Hx frequent prior episodes
• Dx COPD Exacerbation if Hx suggestive of COPD

** Rhonchi:  same as for “Wheezes”

**  Prolonged Expiratory Phase:  same as for “Wheezes”

**  Stridor:  Think Tracheal Obstruction

Cough PLUS Convincing New  SOB (no fever, normal lungs)

• Get CXR
• Normal CXR: Tx for Bronchospasm

See postings Acute Cough – 1 and Acute Cough – 2.