Cough

Objectives

1. In patients presenting with an acute cough:
   • Include serious causes (e.g., pneumothorax, pulmonary embolism [PE]) in the differential diagnosis.
   • Diagnose a viral infection clinically, principally by taking an appropriate history.
   • Do not treat viral infections with antibiotics. (Consider antiviral therapy if appropriate.)
2. In pediatric patients with a persistent (or recurrent) cough, generate a broad differential diagnosis (e.g., gastroesophageal reflux disease [GERD], asthma, rhinitis, presence of a foreign body, pertussis).
3. In patients with a persistent (e.g., for weeks) cough:
   • Consider non-pulmonary causes (e.g., GERD, congestive heart failure, rhinitis), as well as other serious causes (e.g., cancer, PE) in the differential diagnosis. (Do not assume that the child has viral bronchitis).
   • Investigate appropriately. Clinical Reasoning Investigation
4. Do not ascribe a persistent cough to an adverse drug effect (e.g., from an angiotensin-converting enzyme inhibitor) without first considering other causes.
5. In smokers with persistent cough, assess for chronic bronchitis (chronic obstructive pulmonary disease) and make a positive diagnosis when it is present. (Do not just diagnose a smoker’s cough.)