Patient handout

Acute cough (ED triage — undifferentiated adult)

PRODUCTION

1. Your condition

This handout is for acute cough (ed triage — undifferentiated adult). Your care team identified this based on: acute cough <3 weeks — usually viral uri / acute bronchitis / pneumonia / asthma / copd exacerbation (irwin chest 2006 pmid 16428686; chest 2018 pmid 29080708).

Other reasons your team may use this plan: cough + fever + dyspnea + purulent sputum + crackles — community-acquired pneumonia → route pulm.cap.core.v1 (ats pmid 31573350); cough + wheeze + chest tightness + diurnal variability — asthma exacerbation → route pulm.asthma.core.v1 (gina 2025); cough + dyspnea + smoker + sputum production — copd exacerbation → route pulm.copd.core.v1 (gold 2026).

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

oxygen level (SpO₂) <92% on room air OR <88% in known COPD; cough + RR ≥30 + accessory muscle use — hypoxic respiratory failure; O2 + NIV/HFNC; intubate if NIV failure(life-threatening)
CURB-65 ≥3 OR ATS major criteria (mechanical ventilation OR vasopressor) OR ≥3 minor criteria — severe CAP requiring ICU + early antibiotics within 1 h (ATS/IDSA 2019 PMID 31573350)(life-threatening)
peak flow <50% personal best + oxygen level (SpO₂) <92% + silent chest OR no rescue inhaler response — severe asthma exacerbation; rescue inhaler + ipratropium + steroids + IV magnesium 2 g + NIV + ICU (GINA 2025)(life-threatening)
COPD + hypercapnic respiratory failure (pH <7.35, PaCO2 >45) — severe COPD exacerbation; rescue inhaler/SAMA + steroids + antibiotics (Anthonisen) + NIV first-line (GOLD 2026)(life-threatening)
Cough + orthopnea + PND + bilateral leg edema + JVD + elevated natural marker of fluid overload (NT-proBNP) + B-lines on POCUS — cardiogenic cough / acute HF; IV diuretic + nitrates + O2 ± NIV (AHA/ACC/HFSA 2022)
Cough + pleuritic pain + dyspnea + DVT signs OR risk factors + Wells ≥4 OR positive D-dimer → CTA chest; anticoagulation (LMWH/DOAC) → pulm.pe.core.v1; thrombolysis if massive(life-threatening)
Witnessed aspiration / dysphagia / impaired LOC / poor dentition + RLL infiltrate — aspiration pneumonia; broad coverage (pip-tazo + anaerobic if abscess) → pulm.aspiration-pneumonia.core.v1
Subacute/chronic cough + weight loss + night sweats + hemoptysis + TB exposure / endemic travel / homeless / HIV — active TB; airborne IMMEDIATE + sputum AFB × 3 + Xpert MTB/RIF + 4-drug RIPE pending sensitivities (WHO)(life-threatening)
Frank hemoptysis >200 mL/24 h OR hemodynamic instability — massive hemoptysis; protect non-bleeding lung (lateral decubitus bleeding-side down) + tranexamic acid + STAT bronchoscopy + IR embolization → symptom.hemoptysis.v1(life-threatening)
Sudden cough + choking + unilateral breath-sound asymmetry + radiopaque or hyperlucent zones on CXR — FB aspiration (adult or peds); STAT rigid bronchoscopy(life-threatening)
Cough + fever + hypoxia + positive COVID-19 OR influenza PCR + severe disease (NIV/HFNC/intubation) — route id.covid19.core.v1 OR id.influenza.core.v1; antivirals + steroids per protocol

5. Follow-up

Pneumonia: CXR at 6-8 wk in >50 y or smoker (rule out cancer); pneumococcal/flu vaccines. Asthma: controller inhaler + GINA Track 1; spirometry + plan. COPD: GOLD ABE; pulm rehab; smoking cessation. HF cough: the four foundational heart-failure medications optimization. TB: DOT + contact tracing + ID f/u. ACE-i cough: discontinue + ARB. Smoker + cough: USPSTF LDCT screen (PMID 33687470). Chronic cough algorithm (Irwin 2006 PMID 16428686): UACS/asthma/GERD empiric trials

6. Sources

Guideline: 2006 Irwin CHEST cough algorithm + 2018 CHEST acute cough + 2021 USPSTF LDCT lung cancer screening + 2019 ATS/IDSA CAP + 2025 GINA asthma + 2026 GOLD COPD + 2022 AHA/ACC/HFSA HF + 2020 Stevens ACP PE + IDSA influenza + CDC pertussis + WHO TB + RECOVERY dexamethasone for COVID