Acute Cough Management in Urgent Care

Initial Assessment and Management

The American College of Chest Physicians recommends against routine prescription of antibiotics, antitussives, or other medications for acute cough in the urgent care setting, as most cases are viral and self-limiting 1
The British Thoracic Society recommends honey and lemon as first-line treatment for benign viral cough, as it is as effective as pharmacological treatments and costs nothing 2, 3, 4
The American College of Chest Physicians recommends considering acute exacerbation of underlying conditions such as COPD, asthma, or bronchiectasis, rather than simple acute bronchitis, in patients with recurrent episodes 1, 5

The American College of Chest Physicians recommends dextromethorphan 30-60 mg for short-term use only, as the standard OTC dose is subtherapeutic, and maximum cough reflex suppression occurs at 60 mg 2, 4
The American College of Chest Physicians recommends against prescribing codeine or codeine-containing products, as they have no greater efficacy than dextromethorphan but significantly more adverse effects 2, 4

The American Academy of Pediatrics recommends performing diagnostic testing and prescribing macrolide antibiotics if pertussis is suspected, with isolation for 5 days from treatment start 6, 4
The American College of Chest Physicians recommends adjusting chronic disease medications appropriately if underlying asthma or COPD exacerbation is suspected, as this is not uncomplicated acute bronchitis 1, 2

The American Thoracic Society recommends advising patients to return for reassessment if cough persists beyond 3 weeks, worsens despite initial management, or if new concerning symptoms develop 1, 7, 8

The American College of Chest Physicians recommends against prescribing antibiotics reflexively, as this contributes to antimicrobial resistance, and against using subtherapeutic doses of dextromethorphan 1, 2, 6, 4
The American College of Chest Physicians recommends counseling patients about expected duration of symptoms and considering asthma as the underlying cause in patients with recurrent episodes 1, 7, 8

The British Thoracic Society classifies cough based on temporal patterns rather than recurrence, with acute cough lasting less than 3 weeks, subacute cough lasting between 3-8 weeks, and chronic cough lasting greater than 8 weeks 9, 10, 11
Acute cough is typically associated with viral upper respiratory tract infections and is generally self-limiting, lasting less than 3 weeks 9, 10, 11
Subacute cough often represents post-viral cough, lasting between 3-8 weeks 10, 11
Chronic cough requires systematic evaluation for underlying causes, lasting greater than 8 weeks 9, 10, 11

In adults with COPD, what may appear as "recurrent cough" often represents acute exacerbations of the underlying disease, with cough being the commonest symptom associated with acute exacerbations and hospitalizations 9, 12, 13
Patients with COPD may experience baseline chronic cough with episodic worsening, rather than truly "recurrent" episodes 9

Patients presenting with repeated episodes of cough should undergo chest radiography and spirometry to identify underlying chronic lung disease 9, 12, 14
The American College of Chest Physicians is not cited for a relevant recommendation in this context, however, the British Thoracic Society guidelines are relevant 9, 10, 11
True recurrent acute episodes are most commonly viral URTIs occurring 2-5 times per adult per year, while chronic cough and exacerbations of chronic disease require specific diagnostic evaluation and disease-directed therapy 9, 10, 11