![]() ![]() The common cold is a viral rhinosinusitis that often cannot be distinguished clinically from bacterial sinusitis ( 13, 43, 55). There is no convincing evidence of efficacy for intranasal or systemic corticosteroids ( 12, 47), zinc lozenges ( 31, 34, 41) or non-sedating histamine H1 antagonists ( 17, 26). Although the effect on cough was not specifically assessed in a study that showed that intranasal ipratropium provided relief of rhinorrhea and sneezing due to the common cold ( 41), the drug may be helpful for patients who cannot take or tolerate the older-generation antihistamines or naproxen. ![]() These include dexbrompheniramine plus pseudoephedrine ( 54) and naproxen ( 53). In such cases, and if the patient is immunocompetent, radiographic testing is not indicated, because it has a low yield ( 9).įor treating acute cough due to the common cold, there are medications that have been shown to be effective in some randomized, double-blind, placebo-controlled studies ( Table 1). ![]() The common cold is diagnosed when patients present with an acute respiratory illness characterized by symptoms and signs related primarily to the nasal passages (e.g., rhinorrhea, sneezing, nasal obstruction, and postnasal drip), with or without fever, lacrimation, and irritation of the throat, and when a chest examination is normal. During the common cold, cough is due to stimulation of the cough reflex in the upper respiratory tract by upper airway secretions, clearing of the throat, or both ( 6). Without treatment, the prevalence of cough due to the common cold ranges from 83 percent within the first 48 hours of the cold to 26 percent on day 14 ( 6). Viral infections of the upper respiratory tract are the most common causes of acute cough ( 43). It is important to consider and look for evidence of these potentially life-threatening or debilitating disorders in all patients who present with acute cough. However, acute cough also can be the presenting manifestation of infectious pneumonias, left ventricular failure, and diseases of the airways and lung parenchyma (e.g., hypersensitivity pneumonitis, aspiration) ( 17, 18, 54). There have been no studies of the spectrum and frequency of causes of acute cough, but clinical experience suggests that the most common causes are upper respiratory tract infections such as the common cold, acute bacterial sinusitis, pertussis in some communities, exacerbations of chronic obstructive pulmonary disease, allergic rhinitis, and rhinitis due to environmental irritants ( 19, 43). The physician should perform a history and physical examination, considering the estimated frequency of conditions and looking for evidence of potentially life-threatening conditions known to cause cough. It is the duration of the cough at the time of presentation that is important in defining the spectrum of likely causes. Cough is divided into three categories: acute, defined as lasting less than three weeks subacute, lasting three to eight weeks and chronic, lasting more than eight weeks ( 18). CATEGORIZE COUGH BY DURATIONĭetermining the duration of the symptom is the first step in narrowing the differential diagnosis of cough. While the format of this article is similar to that of an article published in the New England Journal of Medicine in 2000, the content has been substantially updated ( 19). Because of the high success rates of therapies directed at specific underlying causes, nonspecific therapy for cough has only a limited role ( 3, 18). The diagnostic and therapeutic approach to cough in adults has evolved significantly in the last decade and has recently been summarized in consensus guidelines ( 17, 18). ![]()
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