Subacute cough

The first step in management is to identify whether the cough preceded an obvious respiratory infection (1).

Post-infectious cough may result from

• postnasal drip
• upper airway irritation
• mucus accumulation
• a manifestation of bronchial hyperresponsiveness that may be associated with asthma
• pneumonia
• an acute exacerbation of chronic bronchitis (1).

Infections such as pertussis (whooping cough) should also be considered.

Suspect pertussis in a patient:

• with an acute cough lasting for 14 days or more with at least one of the following symptoms, post-tussive vomiting, apnoea or whoop
• who has cough for any duration and who has been in contact with a confirmed case of pertussis in the preceding 3 weeks (2)

If the subacute cough is not preceded by an obvious respiratory infection it should be regarded as a chronic cough and should be evaluated and managed accordingly (1).

Reference:

1. Pratter MR, et al. An empiric integrative approach to the management of cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):222S-231S
2. Dodhia H et al. UK guidelines for use of erythromycin chemoprophylaxis in persons exposed to pertussis. J Public Health Med. 2002;24(3):200-6