Cough: Difference between revisions
(Comprehensive expansion of Cough page with EM-focused approach: red flags, evaluation strategy, and management) |
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*Can be classified by duration: | *Can be classified by duration: | ||
**'''Acute:''' <3 weeks — most commonly viral [[URI]], but must consider life-threatening causes | **'''Acute:''' <3 weeks — most commonly viral [[URI]], but must consider life-threatening causes | ||
** | **Subacute: 3-8 weeks — often post-infectious | ||
** | **Chronic: >8 weeks — consider asthma, GERD, post-nasal drip, ACE inhibitors | ||
*The primary ED goal is to identify and treat '''emergent causes''' (PE, pneumothorax, foreign body, anaphylaxis, acute heart failure) and risk-stratify for serious infection | *The primary ED goal is to identify and treat '''emergent causes''' (PE, pneumothorax, foreign body, anaphylaxis, acute heart failure) and risk-stratify for serious infection | ||
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==Management== | ==Management== | ||
*Treat underlying cause | *Treat underlying cause | ||
* | *Viral [[URI]]: Supportive care; honey (>1 year old) has modest evidence for symptom relief<ref>Oduwole O, et al. Honey for acute cough in children. Cochrane Database Syst Rev. 2018;4:CD007094.</ref> | ||
* | *[[Pneumonia]]: Antibiotics per local guidelines (see [[Pneumonia (main)]]) | ||
* | *[[Asthma]]/reactive airway: [[Albuterol]] nebulizer, consider steroids | ||
* | *[[CHF]]: Diuresis, [[nitroglycerin]] (see [[Congestive heart failure]]) | ||
* | *[[PE]]: Anticoagulation (see [[Pulmonary embolism]]) | ||
* | *OTC cough suppressants (dextromethorphan, codeine): Limited evidence of efficacy; avoid codeine in children <12 years | ||
* | *Benzonatate: 100-200 mg PO TID; can cause toxicity if chewed | ||
==Disposition== | ==Disposition== | ||
Latest revision as of 09:28, 22 March 2026
Background
- Cough is a common chief complaint in the ED
- Can be classified by duration:
- Acute: <3 weeks — most commonly viral URI, but must consider life-threatening causes
- Subacute: 3-8 weeks — often post-infectious
- Chronic: >8 weeks — consider asthma, GERD, post-nasal drip, ACE inhibitors
- The primary ED goal is to identify and treat emergent causes (PE, pneumothorax, foreign body, anaphylaxis, acute heart failure) and risk-stratify for serious infection
Clinical Features
- Key history elements:
- Duration, productive vs dry, hemoptysis, fever, dyspnea, chest pain, weight loss
- Medication history (particularly ACE inhibitors)
- Smoking status, occupational/environmental exposures
- Immunocompromised status
- Red flags:
- Hemoptysis
- Acute dyspnea or hypoxia
- Chest pain with cough (consider PE, pneumothorax)
- Stridor or respiratory distress
- Fever with toxic appearance
- Immunocompromised patient with new cough
Differential Diagnosis
Cough
Acute (< 3 wks)
- URI (rhinitis, sinusitis, pertussis)
- LRI (bronchitis, pneumonia)
- Influenza
- Allergy
- Asthma
- Environmental irritants
- Transient airway hyperresponsiveness
- Foreign body
- SARS
Chronic (> 8 wks)
- Postinfectious; pertussis
- Smoking and/or chronic bronchitis
- Postnasal discharge
- Asthma
- GERD
- ACEI/ARB
- CHF
- Lung cancer or intrathoracic mass
- Emphysema
- Interstitial lung disease
- Psychiatric
Evaluation
- Pulse oximetry on all patients
- CXR if:
- Fever, dyspnea, hypoxia, hemoptysis, or abnormal lung exam
- Immunocompromised
- Concern for pneumonia, CHF, pneumothorax, or malignancy
- Persistent cough >3 weeks without clear cause
- Additional workup as indicated:
Management
- Treat underlying cause
- Viral URI: Supportive care; honey (>1 year old) has modest evidence for symptom relief[1]
- Pneumonia: Antibiotics per local guidelines (see Pneumonia (main))
- Asthma/reactive airway: Albuterol nebulizer, consider steroids
- CHF: Diuresis, nitroglycerin (see Congestive heart failure)
- PE: Anticoagulation (see Pulmonary embolism)
- OTC cough suppressants (dextromethorphan, codeine): Limited evidence of efficacy; avoid codeine in children <12 years
- Benzonatate: 100-200 mg PO TID; can cause toxicity if chewed
Disposition
- Admit:
- Pneumonia with sepsis, hypoxia, or significant comorbidities
- PE, pneumothorax, CHF exacerbation
- Massive hemoptysis
- Discharge with follow-up:
See Also
External Links
References
- ↑ Oduwole O, et al. Honey for acute cough in children. Cochrane Database Syst Rev. 2018;4:CD007094.