Acute Cough

An Acute Cough is one which has been going on less than 2-3 weeks.

Anyone with “acute cough” may not be allowed inside a building without a Covid Test. But some patients need to be seen no matter what; every office or clinic has its own mechanism, maybe in a designated exam room, maybe sending them to an Urgent Care or E.R.  These are patients who, in addition to a cough, also have:

• “True” Shortness Of Breath [“SOB” is standard medical abbreviation].
• Fever (>100.6º F; >38.0º C) [especially if >60 years-old]

Causes of Acute Cough

zzzUpper Respiratory Tract Conditions	zzzLower Respiratory Tract Conditions
• Common Cold • Allergic Rhinitis (Hay Fever; “Allergies”) • Sinusitis • Tracheitis (“Croup” in children under 3) • Hypertension Medication (“ACE-Inhibitors”) • (if sudden onset while eating: Aspiration) xxx xxx	• Covid-19 • Influenza (& other viruses) • Pneumonia (both common germs & rare) • Asthma • COPD (exacerbation) • Acute Bronchitis • Heart Failure • Pertussis (“whooping cough”)

For Anatomy, see: Diagram — Upper Respiratory Tract and Diagram — Lower Respiratory Tract. See also Acute Cough — Full Text for an in-depth discussion.

STEP #1  —  Is this Covid?  If going on under 2 wks, assume yes.  Get a Covid Test.

• Test Positive  → diagnosis made; it’s Covid-19
• Test Negative  →  Might still be, but go to Step #2.  May repeat test in 2-3 days; if still Negative,   most likely it’s NOT Covid.
• Results still pending  →  Isolate just in case.  If Dec.- April, and suspect Influenza (abrupt onset, fever, muscles aches, and going on less than 3-4 days). Test or just treat for Influenza

STEP #2  —  If not Covid, or test results pending, is the illness causing COUGH from
…..• Upper Respiratory Tract (from nose, sinuses, throat); or
…..• Lower Respiratory Tract (from the lungs); or
…..• We Can’t Tell ?

Upper Respiratory:  Significant nasal symptoms (runny nose / sneezing / congestion); AND

  —  No Fever, No SOB, Normal Lung Exam (by stethoscope)

• a mild fever is possible at beginning, goes away soon
• fever can occasionally occur with Sinusitis

Lower Respiratory:  Any of the following

• Fever, especially if also muscle aches
• SOB [always a dangerous symptom, if it’s “true” SOB]
• Abnormal Lung Exam (by stethoscope)

Can’t Tell:  Just a “Cough”

• No nasal symptoms, No fever, No SOB
• Normal Lung Exam (by stethoscope)

If We Think LOWER RESPIRATORY cause of COUGH (Covid tests Negative twice)
These may be dangerous; if Covid negative twice, or pending, seek other cause.

Fever &/or Muscle Aches  →  It’s likely Influenza (or another SIMPLE Virus)… UNLESS …

• Going on over 3-4 days without getting even the least bit better
• Rales (crackles) on lung exam (suspect Pneumonia)
• SOB (always makes condition potentially more serious — must check oxygen level)
  • Low oxygen or significant SOB, we often send to E.R. for X-ray and immediate labs
• If any of above, we get a Chest X-ray (will diagnose Pneumonia)
  • Also suspect Pneumonia if: Cough + Fever + Pain with Deep Breath
• Also X-ray if:  Elderly / chronically ill / immunocompromised
  • May send such patients with Cough + Fever to the ER

Bronchospasm by Lung Exam (wheezes, rhonchi, OR prolonged expiration)   →  Diagnose:

**  Viral Bronchitis (if first episode)

**  Asthma (if previous episodes)

**  Chronic Bronchitis (if smoker with history of COPD)

**  Heart Failure (bronchospasm is rare; consider it only if other factors too, see right below)

Shortness of Breath (SOB) —  (and No Fever, No Bronchospasm) [click to explain “true” SOB]

**  Asthma / Chronic Bronchitis : most likely, if otherwise healthy

• Treat on-site.  If symptoms improve  → Diagnosis made.

**  Heart Failure —  possible as cause of cough, especially if any of following:

• Older age, or Risks for Heart Disease
• SOB when lying flat in bed, needs to sit up (this often happens with asthma too)
• Findings on Exam: swollen feet, “rales” in both lungs (wheezes possible, very unusual)

For SOB not improved with asthma treatment, may need to send to ER, esp. if low oxygen

NOTE  —  if patient’s cough is minimal, & SOB is the more prominent symptom, it’s a different thought process for diagnosis (see topic Shortness of Breath).

If We Think UPPER RESPIRATORY cause of COUGH

** Allergic Rhinitis:  any of the following:

• Lots of sneezing
• Similar episodes in the past, especially if lasted over a month
• Findings on exam (pale, boggy mucus membranes inside nose; darkened lower eyelids; horizontal crease across tip of nose on top)

**  Sinusitis (bacteria):

• Facial pressure / constant green mucus (esp. if only one side of face)
• Tap on upper teeth on one side makes the cheek hurt
• Maybe a fever
• Main Way to Diagnose Sinusitis — “common cold,” going on for a week, suddenly got a lot worse

**  Common Cold:   Neither of the above scenarios. Common Cold is always the most likely diagnosis for an acute cough

If We Can’t Tell if it’s UPPER or LOWER RESPIRATORY
No Nasal symptoms, No fever, No SOB, Normal lung exam

** Tracheitis  —  Most likely diagnosis

** Pertussis  —  Might be, if any of the following:

• Vomit after coughing fits
• Not even starting to get better after 2 weeks
• Contact with unvaccinated infant makes possible-Pertussis risky enough to treat

** Asthma  —  Still a possibility (even though Lung Exam sounds normal)

• Very likely if person already had similar episodes in past, or has been diagnosed already
• Might diagnose new Asthma if no improvement in 2 weeks (too long for Tracheitis)
• No danger waiting, as long as there’s no SOB
• Can always treat with asthma medications (inhalers) anyway

EXTRA  —  Sudden Onset Coughing (Choking) While Eating

** Foreign Body Aspiration

• Only perform a Heimlich if person can’t make a single sound
• NEVER do a Heimlich on someone who’s actively coughing
• Call 911, best from a landline
• If it’s you, & you’re alone, open the door & stumble outside (see Calling 911)

See Acute Cough — Full Text for more in-depth explanations and discussions.