Diferencia entre revisiones de «Cough»

Revisión actual - 09:28 22 mar 2026

Background

Cough is a common chief complaint in the ED
Can be classified by duration:
- Acute: <3 weeks — most commonly viral URI, but must consider life-threatening causes
- Subacute: 3-8 weeks — often post-infectious
- Chronic: >8 weeks — consider asthma, GERD, post-nasal drip, ACE inhibitors
The primary ED goal is to identify and treat emergent causes (PE, pneumothorax, foreign body, anaphylaxis, acute heart failure) and risk-stratify for serious infection

Clinical Features

Key history elements:
- Duration, productive vs dry, hemoptysis, fever, dyspnea, chest pain, weight loss
- Medication history (particularly ACE inhibitors)
- Smoking status, occupational/environmental exposures
- Immunocompromised status
Red flags:
- Hemoptysis
- Acute dyspnea or hypoxia
- Chest pain with cough (consider PE, pneumothorax)
- Stridor or respiratory distress
- Fever with toxic appearance
- Immunocompromised patient with new cough

Differential Diagnosis

Cough

Acute (< 3 wks)

URI (rhinitis, sinusitis, pertussis)
LRI (bronchitis, pneumonia)
Influenza
Allergy
Asthma
Environmental irritants
Transient airway hyperresponsiveness
Foreign body
SARS

Chronic (> 8 wks)

Postinfectious; pertussis
Smoking and/or chronic bronchitis
Postnasal discharge
Asthma
GERD
ACEI/ARB
CHF
Lung cancer or intrathoracic mass
Emphysema
Interstitial lung disease
Psychiatric

Evaluation

Pulse oximetry on all patients
CXR if:
- Fever, dyspnea, hypoxia, hemoptysis, or abnormal lung exam
- Immunocompromised
- Concern for pneumonia, CHF, pneumothorax, or malignancy
- Persistent cough >3 weeks without clear cause
Additional workup as indicated:
- ECG if cardiac cause suspected
- CT-PA if concern for PE
- BNP/NT-proBNP if concern for CHF
- CBC, blood cultures if sepsis or severe pneumonia suspected
- Pertussis testing if clinical suspicion (paroxysmal cough, post-tussive emesis, inspiratory whoop)

Management

Treat underlying cause
Viral URI: Supportive care; honey (>1 year old) has modest evidence for symptom relief^[1]
Pneumonia: Antibiotics per local guidelines (see Pneumonia (main))
Asthma/reactive airway: Albuterol nebulizer, consider steroids
CHF: Diuresis, nitroglycerin (see Congestive heart failure)
PE: Anticoagulation (see Pulmonary embolism)
OTC cough suppressants (dextromethorphan, codeine): Limited evidence of efficacy; avoid codeine in children <12 years
Benzonatate: 100-200 mg PO TID; can cause toxicity if chewed

Disposition

Admit:
- Pneumonia with sepsis, hypoxia, or significant comorbidities
- PE, pneumothorax, CHF exacerbation
- Massive hemoptysis
Discharge with follow-up:
- Uncomplicated URI/acute bronchitis
- Stable pneumonia meeting outpatient criteria
- Provide return precautions: worsening dyspnea, hemoptysis, high fever, inability to tolerate PO

External Links

References

↑ Oduwole O, et al. Honey for acute cough in children. Cochrane Database Syst Rev. 2018;4:CD007094.

Authors:

[1] Oduwole O, et al. Honey for acute cough in children. Cochrane Database Syst Rev. 2018;4:CD007094.

[1]

@@ Línea 1: / Línea 1: @@
+==Background==
+*Cough is a common chief complaint in the ED
+*Can be classified by duration:
+**'''Acute:''' <3 weeks — most commonly viral [[URI]], but must consider life-threatening causes
+**Subacute: 3-8 weeks — often post-infectious
+**Chronic: >8 weeks — consider asthma, GERD, post-nasal drip, ACE inhibitors
+*The primary ED goal is to identify and treat '''emergent causes''' (PE, pneumothorax, foreign body, anaphylaxis, acute heart failure) and risk-stratify for serious infection
+==Clinical Features==
+*Key history elements:
+**Duration, productive vs dry, hemoptysis, fever, dyspnea, chest pain, weight loss
+**Medication history (particularly [[ACE inhibitor|ACE inhibitors]])
+**Smoking status, occupational/environmental exposures
+**Immunocompromised status
+*Red flags:
+**[[Hemoptysis]]
+**Acute [[dyspnea]] or hypoxia
+**[[Chest pain]] with cough (consider [[PE]], [[pneumothorax]])
+**Stridor or respiratory distress
+**[[Fever]] with toxic appearance
+**Immunocompromised patient with new cough
 ==Differential Diagnosis==
-{{Template:Cough DDX}}
+{{Cough DDX}}
+==Evaluation==
+*Pulse oximetry on all patients
+*[[CXR]] if:
+**Fever, dyspnea, hypoxia, hemoptysis, or abnormal lung exam
+**Immunocompromised
+**Concern for [[pneumonia]], [[CHF]], [[pneumothorax]], or [[malignancy]]
+**Persistent cough >3 weeks without clear cause
+*Additional workup as indicated:
+**[[ECG]] if cardiac cause suspected
+**[[CT-PA]] if concern for [[PE]]
+**[[BNP]]/NT-proBNP if concern for [[CHF]]
+**CBC, blood cultures if sepsis or severe pneumonia suspected
+**[[Pertussis]] testing if clinical suspicion (paroxysmal cough, post-tussive emesis, inspiratory whoop)
+==Management==
+*Treat underlying cause
+*Viral [[URI]]: Supportive care; honey (>1 year old) has modest evidence for symptom relief<ref>Oduwole O, et al. Honey for acute cough in children. Cochrane Database Syst Rev. 2018;4:CD007094.</ref>
+*[[Pneumonia]]: Antibiotics per local guidelines (see [[Pneumonia (main)]])
+*[[Asthma]]/reactive airway: [[Albuterol]] nebulizer, consider steroids
+*[[CHF]]: Diuresis, [[nitroglycerin]] (see [[Congestive heart failure]])
+*[[PE]]: Anticoagulation (see [[Pulmonary embolism]])
+*OTC cough suppressants (dextromethorphan, codeine): Limited evidence of efficacy; avoid codeine in children <12 years
+*Benzonatate: 100-200 mg PO TID; can cause toxicity if chewed
+==Disposition==
+*Admit:
+**[[Pneumonia]] with sepsis, hypoxia, or significant comorbidities
+**[[PE]], [[pneumothorax]], [[CHF]] exacerbation
+**Massive [[hemoptysis]]
+*Discharge with follow-up:
+**Uncomplicated [[URI]]/acute bronchitis
+**Stable [[pneumonia]] meeting outpatient criteria
+**Provide return precautions: worsening dyspnea, hemoptysis, high fever, inability to tolerate PO
+==See Also==
+*[[Hemoptysis]]
+*[[Pneumonia (main)]]
+*[[Acute asthma exacerbation]]
+*[[Bronchitis]]
+*[[Pertussis]]
+*[[Croup]]
+==External Links==
 ==References==
+<references/>
 [[Category:Pulmonary]]
+[[Category:Symptoms]]