Assessment and Management of Cough

Immediate Red Flag Assessment

The American College of Physicians recommends checking for respiratory distress, abnormal vital signs, or systemic illness appearance to determine if urgent intervention is required 1
The American Thoracic Society suggests clarifying hematemesis vs. hemoptysis, as true hemoptysis is a red flag requiring immediate chest X-ray 2, 1
The American College of Physicians recommends checking for weight loss, night sweats, or history of immunosuppression, as these high-risk features mandate chest X-ray 1

The American Academy of Allergy, Asthma, and Immunology recommends obtaining specific details about medication review, particularly ACE inhibitors which cause chronic cough 2
The American Thoracic Society suggests obtaining specific details about smoking status and environmental exposures 2, 1
The American Academy of Allergy, Asthma, and Immunology recommends obtaining specific details about timing and triggers, such as cough worse at night, with exercise, cold air, or laughing, which suggests asthma 4

The American College of Physicians recommends performing targeted examination focusing on vital signs, including fever, tachypnea, oxygen saturation, and blood pressure 1
The American Thoracic Society suggests performing lung auscultation to check for wheezing, prolonged expiratory phase, crackles, or focal findings 4, 1

The American Academy of Allergy, Asthma, and Immunology recommends that spirometry is essential to objectively assess for airflow obstruction and reversibility 4
The American Thoracic Society suggests that if spirometry shows obstruction with reversibility, diagnose asthma and initiate treatment with inhaled bronchodilators and corticosteroids 4, 3

The American College of Physicians recommends first-generation antihistamine plus decongestant combination to address post-nasal drip 1, 5
The American Academy of Allergy, Asthma, and Immunology suggests inhaled short-acting beta-agonists for immediate bronchodilation in suspected asthma exacerbation 3
The American Thoracic Society recommends systemic corticosteroids if moderate-severe exacerbation 3

The American College of Physicians recommends not prescribing antibiotics unless there is clinical evidence of bacterial pneumonia 5, 3
The American Academy of Allergy, Asthma, and Immunology suggests not relying on peak flow meters for diagnosis, as they are monitoring tools, not diagnostic 4

The American College of Physicians recommends return immediately or call if breathing difficulty develops, true hemoptysis occurs, or fever develops or persists 1, 3
The American Thoracic Society suggests scheduling follow-up if cough persists beyond 3 weeks despite treatment or beyond 8 weeks 5, 3, 2

The American Thoracic Society recommends HRCT scan to evaluate for bronchiectasis or interstitial lung disease if symptoms persist despite adequate trials of therapy 2
The American Gastroenterological Association suggests 24-hour esophageal pH monitoring if GERD suspected but not responding to PPI therapy 2
The American Thoracic Society recommends bronchoscopy to evaluate for occult airway disease, eosinophilic bronchitis, or endobronchial lesions 2