Acute cough

Acute cough is the most common new presentation in 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, and 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).

Other infective causes of cough include COVID-19, pneumonia, acute exacerbations of asthma, chronic obstructive pulmonary disease or bronchiectasis (which may also be noninfective exacerbations), and viral-induced wheeze, bronchiolitis, croup or whooping cough. Non-infective causes may include lung cancer, a foreign body, interstitial lung disease, pneumothorax, pulmonary embolism, heart failure, use of certain medicines (for example, an angiotensin-converting enzyme inhibitor), upper airway cough syndrome (post-nasal drip), or gastro-oesophagal reflux disease. (6)

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
5. NICE (February 2019). Cough (acute): antimicrobial prescribing