Management of Acute Cough

Diagnosis and Assessment

The American College of Chest Physicians suggests that a fever ≥ 38°C (100.4°F) is a specific clinical finding that suggests pneumonia 3
Tachycardia (heart rate > 100 bpm) is another clinical finding that suggests pneumonia, according to the American College of Chest Physicians 3
The American College of Chest Physicians recommends assessing for signs of respiratory distress, including increased respiratory rate, breathlessness, intercostal retractions, cyanosis, or altered consciousness 1, 2
Evaluating for risk factors that increase complication risk, such as comorbidities, frailty, impaired immunity, or reduced ability to cough and clear secretions, is crucial in managing acute cough, as suggested by the American College of Chest Physicians 1, 2

The American College of Chest Physicians recommends providing symptomatic treatment, including adequate fluid intake to avoid dehydration (no more than 2 liters per day) 1, 2
The American College of Chest Physicians suggests advising paracetamol (acetaminophen) for fever and associated achiness 1, 2
The American College of Chest Physicians recommends considering a first-generation antihistamine/decongestant combination for cough associated with the common cold, as double-blind placebo-controlled studies show this decreases cough severity and hastens resolution of cough and postnasal drip 4, 1, 2
The American College of Chest Physicians suggests considering honey for cough suppression if culturally acceptable 1, 2
The American College of Chest Physicians recommends considering naproxen (NSAID) as it has been shown to favorably affect cough in the common cold 4

The European Respiratory Society suggests considering cardiac failure in patients aged > 65 years with orthopnea, displaced apex beat, and/or history of myocardial infarction 5
The European Respiratory Society recommends considering aspiration pneumonia if the patient has difficulties with swallowing, and obtaining a chest radiograph if suspected 5

The American College of Chest Physicians recommends reclassifying the cough as subacute if symptoms persist beyond 3 weeks and reassessing 1, 6
The American College of Chest Physicians suggests advising the patient to return if they develop worsening dyspnea, high fever (> 38.5°C), chest pain, or signs of respiratory distress 1, 2