By vgreene, 2 October, 2020 Postnasal drip/UACS: Consider nasopharyngoscopy, sinus imaging, allergy eval, or empiric tx, per AACP;1 ERS recommends against sinus CT. Tx w/ 1st-gen3 antihistamine + decongestant1,3
By vgreene, 2 October, 2020 If pertussis strongly suspected based on clinical picture (less severe, typical “whoop” less freq in adolescents/adults), strongly consider tx awaiting test results7
By vgreene, 2 October, 2020 Consider TB in endemic area/hi-risk pt, even if CXR NL,1 consider sputum AFB3
By vgreene, 2 October, 2020 If immunocompromised w/ CXR(-) & common cough causes excluded, test for dz assoc w/immunocompromise6
By vgreene, 2 October, 2020 If cough hypersensitivity (cold air, perfume, smoke, bleach) manage exposures3
By vgreene, 2 October, 2020 Hx obstructive airway dz. Chronic bronchitis:4 Stop smoking/exposures; insufficient evidence for abx, bronchodilators, mucolytics, etc;4 optimize COPD or asthma tx. Bronchiectasis: Use airway clearance techniques5
By vgreene, 2 October, 2020 If cause unclear, ✓CXR, spirometry3 (selectively CT,1,3 occupational eval, bronch, etc1) & consider 4- to 6-wk1 sequential3 tx trials for most common causes: asthma, nonasthmatic eosinophilic bronchitis (NAEB), postnasal drip, GERD1/esophageal dysm
By vgreene, 2 October, 2020 If smoking or drug effect (ACEI, sitagliptin,1 bisphosphonates or CCBs may worsen reflux; prostanoid eye drops3): D/C ≥4wk, then reassess.1 Ceasing smoking may transiently ↑cough3
By vgreene, 2 October, 2020 Manage as chronic cough. Consider COVID-19 (wet or dry cough), consider pertussis. ✓hx/ex, incl smoking, triggers, environment1 (incl in athletes2) occupation, travel, ✓red flags (hemoptysis, SOB, systemic sx, etc),1 r/o life-threatening dz
By vgreene, 2 October, 2020 Consider common causes of postinfectious cough, incl new-onset & exac of chronic conditions.1,7 Tx provoking factors (postnasal drip, asthma, GERD), then consider empiric tx trial (eg, inhaled steroids/other agents)7
