Assessment of Postinfectious Cough in Adults

Definition and Classification

Postinfectious cough is defined as cough that persists following symptoms of an acute respiratory infection for at least 3 weeks but not more than 8 weeks, according to the American Thoracic Society 4, 5
Cough lasting longer than 8 weeks should be reclassified as chronic cough and evaluated accordingly, as recommended by the American College of Chest Physicians 4, 3

The initial assessment of postinfectious cough should include screening for red flags, such as hemoptysis, significant weight loss, and voice changes, as recommended by the American College of Chest Physicians 1, 3
A medication review, particularly for ACE inhibitors, which can cause persistent cough, should be performed, as suggested by the British Thoracic Society 8
Smoking history should be assessed, as there is a dose-related association with persistent cough, according to the American Thoracic Society 8

Postinfectious cough can be associated with several underlying mechanisms, including postviral airway inflammation (48.4% of cases), upper airway cough syndrome (33.2% of cases), cough-variant asthma (15.8% of cases), and nonasthmatic eosinophilic bronchitis (5.4% of cases), as reported by the American College of Chest Physicians 1

Pertussis should be suspected in patients with cough lasting ≥2 weeks accompanied by paroxysms of coughing, post-tussive vomiting, or inspiratory whooping sound, as recommended by the Centers for Disease Control and Prevention 5, 7
Consider bronchoscopy only when foreign body aspiration is suspected, as suggested by the British Thoracic Society 8

Patients should be routinely followed up within 4-6 weeks after initial evaluation, and if cough persists beyond 8 weeks, it should be reclassified as chronic cough and further evaluation should be pursued, as recommended by the American College of Chest Physicians 1, 3
Validated cough severity tools should be used to objectively assess treatment response, as suggested by the American Thoracic Society 1, 3

Failing to consider pertussis in adults with prolonged cough, which is often underdiagnosed, as warned by the Centers for Disease Control and Prevention 5, 7
Overlooking gastroesophageal reflux as a potential contributor to persistent cough, as cautioned by the American Gastroenterological Association 8, 5
Inappropriate use of antibiotics for non-bacterial causes of postinfectious cough, as advised against by the American College of Chest Physicians 4, 5