acute cough

Last reviewed 06/2021

Acute cough is the most common new presentation in the primary care

• usually they are benign and self limiting (if there is no significant co-morbidity)
• upper respiratory tract infection is responsible for a majority of cases (1)

In a majority of patients a medical history and a physical examination is sufficient to differentiate serious conditions from non-life-threatening conditions (2)

• patients with symptoms and signs of rhinorrhea, sneezing, nasal obstruction, irritation of the throat with or without fever, lacrimation and with a normal chest examination are most likely to have an upper respiratory tract infection (3)
• acute cough with or without sputum production may be due to acute bronchitis (after excluding pneumonia, common cold, acute asthma, or an acute exacerbation of COPD) (4)
• acute cough with fever, malaise, purulent sputum or with a history of recent infection leads to a suspicion of serious acute lung infection (1).

Patients with additional chest signs and/or respiratory symptoms like haemoptysis, breathlessness, chest pain, fever, weight loss should undertake chest radiography to exclude possible serious life threatening conditions (1)

A normal chest x-ray can be seen in the following patients with acute cough - viral respiratory tract infections (influenza, RSV, rhinovirus), bacterial infections (acute bronchitis), inhaled foreign body, inhaled toxic fumes (1)

Further investigations are indicated in patients with haemoptysis, prominent systemic illness, suspicion of inhaled foreign body and suspicion of lung cancer (1).

Reference:

• 1. Morice AH et al. Recommendations for the management of cough in adults. Thorax. 2006;61 Suppl 1:i1-24
• 2. Dicpinigaitis PV et al. Acute cough: a diagnostic and therapeutic challenge. Cough. 2009;5:11
• 3. Irwin RS, Madison JM. The Diagnosis and Treatment of Cough. N Engl J Med 2000; 343:1715-172
• 4. Braman SS. Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):95S-103S