Cough Management in the Emergency Department

Assessment and Classification

The American College of Chest Physicians recommends determining if the cough is acute (<3 weeks), subacute (3-8 weeks), or chronic (>8 weeks) to guide treatment approach 1
Identifying potential underlying causes such as postinfectious inflammation, upper airway cough syndrome, asthma, or gastroesophageal reflux disease is crucial for effective management 1, 3
Assessing for paroxysmal cough with post-tussive vomiting or inspiratory whooping sound may indicate Bordetella pertussis infection 1

Inhaled ipratropium bromide is recommended as first-line therapy for postinfectious cough as it may attenuate cough 1, 2
Central-acting antitussives such as codeine and dextromethorphan should be considered when other measures fail for postinfectious cough 1, 2
Inhaled corticosteroids may be used when cough adversely affects quality of life and persists despite ipratropium 1
Oral prednisone (30-40 mg daily for a short period) may be considered for severe paroxysms of postinfectious cough when other common causes have been ruled out 1

For suspected pertussis, macrolide antibiotics (erythromycin, clarithromycin, or roxithromycin) should be administered early in the course of infection 1, 6
For cough associated with upper airway cough syndrome, first-generation antihistamine/decongestant preparations are recommended 5
For cough associated with lung cancer, centrally acting cough suppressants such as dihydrocodeine and hydrocodone are recommended 6

Antibiotics have no role in treating postinfectious cough unless there is evidence of bacterial infection 1
In severe asthma exacerbations, avoid sedatives which can suppress respiratory drive 4
For patients with reduced level of consciousness, cough suppressants should be used with caution due to risk of aspiration 6