Management of Subacute Cough

Initial Assessment and Diagnosis

The American College of Emergency Physicians suggests that at 12 days duration, a cough is considered subacute, most likely post-infectious in origin, and should be treated with inhaled ipratropium bromide as first-line therapy, with reassurance that spontaneous resolution is expected 1, 2
The American Academy of Emergency Medicine recommends ruling out pertussis if the patient has paroxysmal cough, post-tussive vomiting, or inspiratory whooping sound, and obtaining a nasopharyngeal culture and macrolide antibiotics if confirmed 2, 4
The American College of Chest Physicians advises obtaining a chest radiograph only if there are suspicions of pneumonia based on vital sign abnormalities or focal consolidation findings on exam 3, 1

The American College of Physicians recommends prescribing inhaled ipratropium bromide as first-line therapy for post-infectious cough, as it has demonstrated efficacy in controlled trials for attenuating cough 2
The American Academy of Family Physicians suggests providing reassurance that post-infectious cough resolves spontaneously over time, typically within 3-8 weeks total from symptom onset 2, 4
The American College of Chest Physicians advises against prescribing antibiotics unless there is confirmed bacterial sinusitis or pertussis, as bacterial infection does not play a role in post-infectious cough pathogenesis 2, 4

The American College of Physicians recommends reclassifying a cough as chronic if it persists beyond 8 weeks total and initiating a systematic evaluation, starting with treatment for upper airway cough syndrome (UACS) with a first-generation antihistamine-decongestant combination 1
The American Thoracic Society suggests evaluating for asthma if UACS treatment fails, and initiating intensive GERD therapy if both UACS and asthma treatments fail 5, 1

The American Academy of Emergency Medicine warns against failing to recognize the 8-week threshold where post-infectious cough becomes chronic cough requiring different evaluation 1, 2
The American College of Physicians advises against inappropriate antibiotic use for non-bacterial post-infectious cough, as it wastes resources and promotes resistance 2, 4