Differential Diagnosis and Treatment for Persistent Dry Cough with Mild Sore Throat

Differential Diagnosis

The American College of Chest Physicians recommends that a 4-day duration of dry cough with mild sore throat and dryness, triggered by cold air and talking, without fever or systemic symptoms, is classic for viral upper respiratory tract infection (common cold) 2, 3
The absence of fever, shortness of breath, tachycardia, tachypnea, or focal chest findings makes pneumonia extremely unlikely and eliminates the need for chest radiography, as suggested by the American College of Emergency Physicians 4, 5, 3
Cough triggered by cold environment and talking suggests upper airway irritation and postnasal drip (upper airway cough syndrome), according to the American College of Chest Physicians 1, 6

The American College of Chest Physicians recommends against prescribing antibiotics for viral acute bronchitis or upper respiratory tract infection, as they provide no benefit, contribute to antimicrobial resistance, and cause adverse effects 2, 5, 3
Symptomatic relief with first-generation antihistamine/decongestant combination is recommended, such as brompheniramine/pseudoephedrine or chlorpheniramine/phenylephrine, as suggested by the American College of Chest Physicians 1, 6, 8
Inhaled ipratropium bromide may be prescribed for severe cough, with 2-3 puffs four times daily, as recommended by the American College of Chest Physicians 7, 8, 3
Supportive measures, including voice rest, adequate hydration, and simple home remedies like honey and lemon, are also recommended, as suggested by the American College of Chest Physicians 3, 10

The American College of Chest Physicians recommends never prescribing antibiotics for viral upper respiratory tract infection or acute bronchitis 2, 5, 3
The American Academy of Otolaryngology recommends against using nasal decongestant sprays beyond 3-5 days due to rebound congestion risk 8, 3, 10
The American College of Chest Physicians recommends considering pertussis if paroxysmal cough or post-tussive vomiting develops, even in vaccinated patients 7, 8