Managing Acute Cough

Initial Assessment and Red Flags

The American Thoracic Society recommends determining whether a cough represents a serious illness or a benign condition, with red flags including fever with rapid breathing or shortness of breath, chest pain or difficulty breathing, coughing up blood, and signs of pneumonia on examination 3, 4
The American College of Chest Physicians suggests that key questions to answer include whether the patient is taking an ACE inhibitor medication, smokes, or has symptoms that started after a cold or flu 1, 2, 5

The American Academy of Family Physicians states that viral upper respiratory infections are the most frequent cause of acute cough, and the most effective treatment is a first-generation antihistamine combined with a decongestant 1, 6
The American College of Chest Physicians recommends additional supportive measures, including nonsteroidal anti-inflammatory drugs, rest, hydration, and avoiding irritants and allergens 6, 4

The American Thoracic Society advises that antibiotics should not be used for viral causes of acute cough, as they provide no benefit and contribute to antibiotic resistance 2, 4
The European Respiratory Society suggests that cough suppression may be harmful when clearance of secretions is important, such as in pneumonia or bronchiectasis 5, 2
The American College of Chest Physicians recommends that patients with persistent cough beyond 3 weeks should be evaluated for underlying conditions, including upper airway cough syndrome, asthma, and gastroesophageal reflux disease 7, 2, 4