Cough Treatment Guidelines

Exclusions for Self-Treatment

• Difficulty breathing, shortness of breath (dyspnea)
• Cyanosis (pale/blue face)
• Hemoptysis (coughing up blood)
• Weight loss
• Night sweats
• Cough worsening after 3-5 days or not subsiding after 2-3 weeks
• Children under 4 years old
• Temperature ≥100.4°F (38°C) (oral), or ≥100°F (37.8°C) (oral) lasting >3 days
• Barking cough with inspiratory stridor (croup)
• Severe coughing spells ending with a "whooping" sound (whooping cough)
• Sudden cough without fever or URI symptoms (aspiration)
• Immunocompromised status
• Exposure history to tuberculosis
• Risk factors for HIV infection
• Chronic illness (asthma, COPD, CHF, diabetes, sickle cell anemia)

Cough Treatment

• Cough with or without mucus associated with upper respiratory illness (URI): Consider as a common cold. Nondrug measures recommended. If symptoms improve, continue treatment until resolved. Otherwise, medical referral is necessary.
• Dry cough persisting after viral URI: Nondrug measures and first-generation antihistamine plus decongestant. If symptoms do not improve, seek medical attention.
• Cough likely associated with UACS (Upper Airway Cough Syndrome): Initial nondrug measures. If symptoms improve, continue treatment until resolved. Otherwise, seek medical attention; need for medical referral.

Cough Phases

• Cough occurs in 3 phases: inspiratory, compressive, and expulsive.

Cough Pathophysiology

• Triggers include smoke, perfumes, scents, throat irritation, noxious fumes, speech, exercise, cold/dry air, eating, and humidity.

Cough Clinical Presentation

• Productive (Wet) Cough: Expels secretions from lower respiratory tract. Can be effective or ineffective, depending on the nature of the secretions (clear, purulent, discolored, malodorous)
• Non-productive (Dry) Cough: Associated with viral respiratory tract infections, GERD, cardiac diseases, and certain medications.

Non-Pharmaceutical Treatments

• Stay hydrated
• Reduce throat irritation
• Increase air moisture
• Treat the underlying cause of the cough

Over-the-Counter (OTC) Medications

• Anti-tussives (Cough Suppressants): Control or eliminate cough (for non-productive coughs only). Topical examples include menthol or camphor; codeine (schedule 2 drug); dextromethorphan (Delsym); diphenhydramine (Benadryl). Important note: use diphenhydramine products with caution and consult a medical professional before mixing with other medications.
• Protussives (Cough Expectorants): Changes the consistency of mucus and increases volume of expectorated sputum. Guaifenesin (Mucinex) is an example.

Special Populations

• Pregnancy: Dextromethorphan (Delsym) is generally considered safe; avoid Codeine, Dextromethorphan (Delsym), or Diphenhydramine (Benadryl).
• Lactation (breastfeeding): Avoid Codeine, Dextromethorphan (Delsym), and Diphenhydramine (Benadryl).
• Elderly: Start with lower doses of Codeine, Dextromethorphan (Delsym), and Diphenhydramine (Benadryl) to mitigate potential sedative effects.
• Drug Interactions: Phenytoin inhibits CYP450, and diphenhydramine is metabolized by CYP450; consult a doctor about possible drug interactions.

Additional Considerations

• Children (under 2 years old): Avoid OTC cough products prescribed for adults; consult a pediatrician.
• Exclusions for self-treatment: Cough lasting longer than 7 days, excessive fever, cough accompanied by shortness of breath, chest pain, etc. require immediate medical evaluation.

This quiz covers essential guidelines for cough treatment and exclusions for self-treatment. It focuses on specific symptoms and conditions that require medical attention, along with recommended treatment for common upper respiratory illnesses. Understanding these guidelines is crucial for effective cough management.