Evaluation and Management of Cough in Adults (Acute, Sub‑acute, and Chronic)
1. Initial Critical Assessment – Rule‑out of Life‑Threatening Causes
Immediately exclude pneumonia and pulmonary embolism before initiating empirical treatment for viral respiratory infection. – American College of Chest Physicians recommendation. 1, 2
2. Red‑Flag Features Prompting Urgent Evaluation
Presence of any of the following in a patient with acute cough warrants immediate investigation:
3. Essential History Elements for All Cough Presentations
Key questions to ask during the initial interview:
4. Most Likely Etiology of a One‑Week Cough (Acute Cough)
In patients with a cough lasting ≤ 7 days, the predominant cause is a viral respiratory tract infection (common cold or acute bronchitis). – American College of Chest Physicians. 1, 2
Secondary considerations include exacerbation of a pre‑existing respiratory condition or environmental/allergic exposure. – American College of Chest Physicians. 1, 2
5. Management When No Red Flags Are Present (Acute Viral Cough)
Reassure the patient and provide symptomatic relief; antibiotics are ineffective. – Thorax Society guideline. 5
6. Indications for Escalation of Evaluation (Beyond Acute Phase)
Urgent reassessment is advised if any of the following develop:
7. Sub‑Acute Cough (3–8 weeks) – Post‑Infectious Management
First‑line therapy: trial of inhaled ipratropium bromide. – Chest Society consensus. 6, 7, 8
If quality of life remains impaired after ipratropium: add inhaled corticosteroids. – Chest Society. 6, 7, 8
For severe paroxysmal cough after exclusion of other causes: a short course of oral prednisone 30–40 mg daily. – Chest Society. 6, 7, 8
When above measures fail: consider central antitussives (codeine or dextromethorphan). – Chest Society. 6, 7, 8
8. Pertussis Consideration in Sub‑Acute Cough
Suspect pertussis when cough ≥ 2 weeks is accompanied by paroxysms, post‑tussive vomiting, or an inspiratory whoop. – Chest Society. 6, 7, 8
9. Chronic Cough (> 8 weeks) – Systematic Diagnostic Algorithm
Sequential evaluation of the most common causes:
10. Additional Work‑up for Chronic Cough
Baseline investigations to exclude serious pathology: