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COUGH - Coggle Diagram

- - - - Onset of symptoms.
      - Duration of cough.
      - Frequency of cough.
      - Type of cough (dry or productive).
      - Precipitating or exacerbating factors.
      - Diurnal variation.
      - Associated symptoms – throat, chest, gastrointestinal.
      - Smoking history.
      - Environmental factors.
      - Occupational history.
      - Family history.
      - Recent respiratory tract infection.
      - Recent travel history.
  - - - Haemoptysis.
      - Hoarseness.
      - Peripheral oedema with weight gain.
      - Prominent dyspnoea, especially at rest or at night.
      - Smokers aged over 45 years with a new cough, change in cough, or coexisting voice disturbance, and smokers aged 55–80 years who have a 30 pack-year smoking history and currently smoke or who have quit within the past 15 years.
      - Systemic symptoms, such as fever or weight loss.
      - Trouble swallowing.
      - Vomiting.
- - - - For people with sub-acute cough (3–8 weeks' duration):
      - Assess whether the person has clinical features of the most common cause:
      - Post-infectious cough — for example, after infections with Mycoplasma pneumonia or Bordetella pertussis. This is suggested by persistent dry cough that started with an obvious respiratory tract infection, and the person is systemically well with a normal respiratory examination.
- - - - Upper respiratory tract infection
      - Advise them:
      - That acute cough usually persists for up to 3 or 4 weeks.
      - How to manage their symptoms with self-care (for example, paracetamol or ibuprofen for any associated pain). Be aware that some people may wish to try honey, pelargonium (a herbal medicine), or over the counter medicines that contain the expectorant guaifenesin or cough suppressants.
      - To seek medical advice if symptoms worsen rapidly or significantly, do not improve in 3–4 weeks, or they become systemically very unwell.
      - That if they smoke, they should stop. For more information, see the CKS topic on Smoking cessation.
      - Do not offer the following treatments unless the person has an underlying airways disease (for example, asthma):
        
        An oral or inhaled bronchodilator (for example, salbutamol).
        
        An oral or inhaled corticosteroid.
        
        Do not offer a mucolytic (for example, acetylcysteine or carbocisteine).
        
        Do not offer an antibiotic to people who are not systemically very unwell or at higher risk of complications.
        
        Give advice about why an antibiotic was not given.
        
        For people identified at a face-to-face clinical examination as systemically very unwell, offer an immediate antibiotic — doxycycline 200 mg on the first day, then 100 mg once daily for 4 days (avoid in pregnancy). Or if this is not suitable, alternatives are:
        
        Amoxicillin 500 mg three times daily for 5 days.
        
        Clarithromycin 250 mg to 500 mg twice daily for 5 days.
        
        Erythromycin 250 mg to 500 mg four times daily (or 500 mg to 1000 mg twice daily) for 5 days.
        
        For people identified as at higher risk of complications, consider:
        
        An immediate antibiotic.
        
        A back-up antibiotic prescription — give advice that it is not needed immediately and to use it if symptoms worsen rapidly or significantly at any time.
        
        When an antibiotic is given, give advice about possible adverse effects, particularly diarrhoea and nausea.
        
        COVID-19 — follow the Public Health England advice for managing people with COVID-19 in primary care. For information on management, see the CKS topic on Coronavirus - COVID 19.
        
        Acute bronchitis or pneumonia — see the CKS topic on Chest infections - adult for information on management.
        
        Acute exacerbation of asthma, chronic obstructive pulmonary disease (COPD), or bronchiectasis — see the CKS topics on Asthma, Chronic obstructive pulmonary disease, or Bronchiectasis for information on management.
        
        Reassess people with an acute cough if their symptoms worsen rapidly or significantly, taking into account:
        
        Alternative diagnoses.
        
        Any symptoms or signs suggesting a more serious illness or condition, such as cardiorespiratory failure or sepsis.
        
        Previous antibiotic use, which may have led to resistant bacteria.