Cough

Pharmacists play an important role in the assessment and management of patients with cough. By obtaining a focused clinical history from the patient, they can identify patients who need to be referred to their physician or to the emergency room, as well as which patients can be managed at home. Red flags that prompt referral include severe systemic illness, respiratory distress, hemoptysis, and altered level of consciousness. Patients with underlying chronic illnesses such as chronic obstructive pulmonary disease, asthma, and heart failure who present with cough should be assessed for possible exacerbation of their illness and should be referred if this is suspected. Determining the duration of cough is an important step, as this helps identify possible etiologies. Cough <3-week duration is categorized as acute, 3- to 8-week duration is subacute, and > 8-week duration is a chronic cough. Patients with cough lasting >3 weeks should generally be referred for further evaluation and management. Acute cough is often infectious but can also be due to exacerbation of underlying illness or could be medication-related. Upper airway cough syndrome (UACS) is one of the most common causes of subacute and chronic cough. Several different etiologies lead to UACS, which is thought to be caused by postnasal drip ± sensitization of cough receptors in the respiratory tract. First-generation antihistamines or decongestants are therapeutic options when UACS is suspected. It is important to note that antitussive medications such as dextromethorphan can actually prolong illness in patients with a productive cough and are thus not recommended. Monitoring parameters and frequency of follow-up depend on underlying cause, severity of illnesses, past medical history, as well as medication changes.