Cough in adults
Questionnaire/history:
Onset of symptoms?
Duration of cough?
Frequency of cough?
Type of cough (dry or productive)?
Colour of sputum/phlegm?
Precipitating or exacerbating factors?
Diurnal variation?
Associated symptoms?
- Sharp chest pain when breathing deeply (pleuritic pain)?
- Chest pains also when not coughing?
- Difficulty in breathing?
--- On exertion only?
--- At rest?
--- At night?
- Wheezing?
- Coughing up blood (haemoptysis)?
- Fever?
- Maximum temperature?
- Sweats?
- Chills?
- Runny nose?
- Nasal or sinus congestion?
- Dark yellow or green nasal discharge?
- Sore throat?
- Hoarseness?
- Trouble swallowing?
- Fatigue?
- Muscle and joint aches?
- Headache?
- New loss of smell or taste?
- Nausea/vomiting/diarrhoea?
- Peripheral oedema with weight gain?
Covid-19 lateral flow tests?
Past medical history?
- Higher risk of complications?
--- Pre-existing comorbidity?
--- Young children born prematurely?
--- Over 65 years with 2 or more of, or > 80 with 1 or more of:
------ Hospitalisation in previous year?
------ Type 1 or 2 diabetes?
------ History of congestive heart failure?
------ Current use of oral corticosteroids?
Family history?
Smoking history?
Recent travel history?
Current medication?
Known drug allergies?
Occupational history?
(Leicester Cough questionnaire)?
Examination:
Altered level of consciousness?
Blood pressure?
Pulse?
Temperature?
SpO2?
RR?
Throat inspection?
Ear inspection?
Use of accessory muscles of respiration?
Chest auscultation?
(Heart auscultation?)
NEWS2?
CRB65 score?
- Confusion?
- RR >30?
- SBP <90 or DBP <60mmHg?
- Age 65+?
Investigations:
Respiratory panel?
Procalcitonin?
CPR?
- 20mg/L or less?
- 20-100mg/L?
- >100mg/L?
FBC?
Pertussis serology?
QuantiFERON test?
Sputum culture?
Peak flow?
Spirometry?
CXR?
Diagnosis:
Upper RTI?
Acute bronchitis?
Pneumonia?
Possible Covid-19 infection?
Confirmed Covid-19 infection by PCR test?
Acute exacerbation of a pre-existing condition:
- Upper airway cough syndrome (post-nasal drip)?
- Asthma?
- COPD?
GORD?
Pertussis?
Pulmonary embolism?
Pneumothorax?
Post-infectious cough?
Sub-acute cough (3-8 weeks) (?cause)?
Chronic cough (8+ weeks) (?cause)?
Other?
Management:
Ambulance called and referred to A&E?
As acute onset of cough and systematically very unwell (or higher risk of complications)
- Doxycycline 200 mg on first day, then 100 mg once a day for 4 days (5-day course in total)? - Amoxicillin 500 mg tds for 5 days?
- Clarithromycin 500 mg bd for 5 days?
- Erythromycin (in pregnancy) 250 – 500 mg qds or 500 – 1000 mg bd for 5 days?
As higher risk of complications back-up Rx for abx given with the advice to take it, if symptoms worsen rapidly or significantly at any time, and advice about possible adverse effects, particularly diarrhoea and nausea?
Home care advice given?
Acute coughs are usually self-limiting but can last up to 3 to 4 weeks Usually caused by a viral upper respiratory tract infection such as a cold or flu Antibiotics make little difference to how long a cough lasts
To drink plenty of fluids (to aim half a litre every four hours)
Paracetamol and/or ibuprofen with food (if no nausea or vomiting) for any associated pain
Could try: Hot lemon and honey (squeeze half a lemon into a mug of boiled water and add 1 to 2 teaspoons of honey) eg four times daily Herbal remedy pelargonium root extract (eg Benylin Herbal Cough & Cold Sugar Free Syrup) to support the immune system
Expectorant guaifenesin (eg Benylin Mucus Cough Max) to thinnen and loosen the mucus (phlegm) to make it easier to cough up
Cough suppressant dexatromethorphan (if the cough is not persistent, such as in asthma, or accompanied by excessive secretions) (eg Benylin Dry Coughs) To seek medical advice if new or rapidly or significantly worsening symptoms (eg a lot of dark yellow, green or brown phlegm, worsening chest pains, shortness of breath or fever) or symptoms do not improve in 3-4 weeks or becoming systemically very unwell
Smoking cessation (if smoker)