Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza

CHEST Guideline and Expert Panel Report

CHEST Expert Cough Panel

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Patients commonly present to primary care services with upper and lower respiratory tract infections, and guidelines to help physicians investigate and treat acute cough due to suspected pneumonia and influenza are needed. Methods: A systematic search was carried out with eight patient, intervention, comparison, outcome questions related to acute cough due to suspected pneumonia or influenza. Results: There was a lack of randomized controlled trials in the setting of outpatients presenting with acute cough due to suspected pneumonia or influenza who were not hospitalized. Both clinical suggestions and research recommendations were made on the evidence available and CHEST Expert Cough Panel advice. Conclusions: For outpatient adults with acute cough due to suspected pneumonia, we suggest the following clinical symptoms and signs are suggestive of pneumonia: cough; dyspnea; pleural pain; sweating, fevers, or shivers; aches and pains; temperature ≥ 38°C; tachypnea; and new and localizing chest examination signs. Those suspected of having pneumonia should undergo chest radiography to improve diagnostic accuracy. Although the measurement of C-reactive protein levels strengthens both the diagnosis and exclusion of pneumonia, there was no added benefit of measuring procalcitonin levels in this setting. We suggest that there is no need for routine microbiological testing. We suggest the use of empiric antibiotics according to local and national guidelines when pneumonia is suspected in settings in which imaging cannot be performed. Where there is no clinical or radiographic evidence of pneumonia, we do not suggest the routine use of antibiotics. There is insufficient evidence to make recommendations for or against specific nonantibiotic, symptomatic therapies. Finally, for outpatient adults with acute cough and suspected influenza, we suggest that initiating antiviral treatment (according to Centers for Disease Control and Prevention advice) within 48 hours of symptoms could be associated with decreased antibiotic use and hospitalization and improved outcomes.

Original languageEnglish (US)
Pages (from-to)155-167
Number of pages13
JournalChest
Volume155
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Cough
Human Influenza
Pneumonia
Outpatients
Guidelines
Anti-Bacterial Agents
Pain
Thorax
Tachypnea
Sweating
Calcitonin
Centers for Disease Control and Prevention (U.S.)
Radiography
Respiratory Tract Infections
Dyspnea
C-Reactive Protein
Signs and Symptoms
Antiviral Agents
Primary Health Care
Hospitalization

Keywords

  • cough
  • evidence-based medicine
  • guidelines
  • influenza
  • pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza : CHEST Guideline and Expert Panel Report. / CHEST Expert Cough Panel.

In: Chest, Vol. 155, No. 1, 01.01.2019, p. 155-167.

Research output: Contribution to journalArticle

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abstract = "Background: Patients commonly present to primary care services with upper and lower respiratory tract infections, and guidelines to help physicians investigate and treat acute cough due to suspected pneumonia and influenza are needed. Methods: A systematic search was carried out with eight patient, intervention, comparison, outcome questions related to acute cough due to suspected pneumonia or influenza. Results: There was a lack of randomized controlled trials in the setting of outpatients presenting with acute cough due to suspected pneumonia or influenza who were not hospitalized. Both clinical suggestions and research recommendations were made on the evidence available and CHEST Expert Cough Panel advice. Conclusions: For outpatient adults with acute cough due to suspected pneumonia, we suggest the following clinical symptoms and signs are suggestive of pneumonia: cough; dyspnea; pleural pain; sweating, fevers, or shivers; aches and pains; temperature ≥ 38°C; tachypnea; and new and localizing chest examination signs. Those suspected of having pneumonia should undergo chest radiography to improve diagnostic accuracy. Although the measurement of C-reactive protein levels strengthens both the diagnosis and exclusion of pneumonia, there was no added benefit of measuring procalcitonin levels in this setting. We suggest that there is no need for routine microbiological testing. We suggest the use of empiric antibiotics according to local and national guidelines when pneumonia is suspected in settings in which imaging cannot be performed. Where there is no clinical or radiographic evidence of pneumonia, we do not suggest the routine use of antibiotics. There is insufficient evidence to make recommendations for or against specific nonantibiotic, symptomatic therapies. Finally, for outpatient adults with acute cough and suspected influenza, we suggest that initiating antiviral treatment (according to Centers for Disease Control and Prevention advice) within 48 hours of symptoms could be associated with decreased antibiotic use and hospitalization and improved outcomes.",
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author = "{CHEST Expert Cough Panel} and Hill, {Adam T.} and Gold, {Philip M.} and {El Solh}, {Ali A.} and Metlay, {Joshua P.} and Belinda Ireland and Irwin, {Richard S.} and Adams, {Todd M.} and Altman, {Kenneth W.} and Elie Azoulay and Barker, {Alan F.} and Birring, {Surinder S.} and Fiona Blackhall and Bolser, {Donald C.} and Boulet, {Louis Philippe} and Braman, {Sidney S.} and Christopher Brightling and Priscilla Callahan-Lyon and Chang, {Anne B.} and Terrie Cowley and Paul Davenport and {El Solh}, {Ali A.} and Patricio Escalante and Field, {Stephen K.} and Dina Fisher and French, {Cynthia T.} and Peter Gibson and Philip Gold and Cameron Grant and Harding, {Susan M.} and Anthony Harnden and Hill, {Adam T.} and Irwin, {Richard S.} and Kahrilas, {Peter J.} and Joanne Kavanagh and Keogh, {Karina A.} and Kefang Lai and Lane, {Andrew P.} and Kaiser Lim and Madison, {J. Mark} and Malesker, {Mark A.} and Stuart Mazzone and Garvey, {Lorcan Mc} and Alex Molasoitis and Abigail Moore and Murad, {Mohammad H} and Mangala Narasimhan and Peter Newcombe and Nguyen, {Huong Q.} and John Oppenheimer and Ryu, {Jay H}",
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T1 - Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza

T2 - CHEST Guideline and Expert Panel Report

AU - CHEST Expert Cough Panel

AU - Hill, Adam T.

AU - Gold, Philip M.

AU - El Solh, Ali A.

AU - Metlay, Joshua P.

AU - Ireland, Belinda

AU - Irwin, Richard S.

AU - Adams, Todd M.

AU - Altman, Kenneth W.

AU - Azoulay, Elie

AU - Barker, Alan F.

AU - Birring, Surinder S.

AU - Blackhall, Fiona

AU - Bolser, Donald C.

AU - Boulet, Louis Philippe

AU - Braman, Sidney S.

AU - Brightling, Christopher

AU - Callahan-Lyon, Priscilla

AU - Chang, Anne B.

AU - Cowley, Terrie

AU - Davenport, Paul

AU - El Solh, Ali A.

AU - Escalante, Patricio

AU - Field, Stephen K.

AU - Fisher, Dina

AU - French, Cynthia T.

AU - Gibson, Peter

AU - Gold, Philip

AU - Grant, Cameron

AU - Harding, Susan M.

AU - Harnden, Anthony

AU - Hill, Adam T.

AU - Irwin, Richard S.

AU - Kahrilas, Peter J.

AU - Kavanagh, Joanne

AU - Keogh, Karina A.

AU - Lai, Kefang

AU - Lane, Andrew P.

AU - Lim, Kaiser

AU - Madison, J. Mark

AU - Malesker, Mark A.

AU - Mazzone, Stuart

AU - Garvey, Lorcan Mc

AU - Molasoitis, Alex

AU - Moore, Abigail

AU - Murad, Mohammad H

AU - Narasimhan, Mangala

AU - Newcombe, Peter

AU - Nguyen, Huong Q.

AU - Oppenheimer, John

AU - Ryu, Jay H

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Patients commonly present to primary care services with upper and lower respiratory tract infections, and guidelines to help physicians investigate and treat acute cough due to suspected pneumonia and influenza are needed. Methods: A systematic search was carried out with eight patient, intervention, comparison, outcome questions related to acute cough due to suspected pneumonia or influenza. Results: There was a lack of randomized controlled trials in the setting of outpatients presenting with acute cough due to suspected pneumonia or influenza who were not hospitalized. Both clinical suggestions and research recommendations were made on the evidence available and CHEST Expert Cough Panel advice. Conclusions: For outpatient adults with acute cough due to suspected pneumonia, we suggest the following clinical symptoms and signs are suggestive of pneumonia: cough; dyspnea; pleural pain; sweating, fevers, or shivers; aches and pains; temperature ≥ 38°C; tachypnea; and new and localizing chest examination signs. Those suspected of having pneumonia should undergo chest radiography to improve diagnostic accuracy. Although the measurement of C-reactive protein levels strengthens both the diagnosis and exclusion of pneumonia, there was no added benefit of measuring procalcitonin levels in this setting. We suggest that there is no need for routine microbiological testing. We suggest the use of empiric antibiotics according to local and national guidelines when pneumonia is suspected in settings in which imaging cannot be performed. Where there is no clinical or radiographic evidence of pneumonia, we do not suggest the routine use of antibiotics. There is insufficient evidence to make recommendations for or against specific nonantibiotic, symptomatic therapies. Finally, for outpatient adults with acute cough and suspected influenza, we suggest that initiating antiviral treatment (according to Centers for Disease Control and Prevention advice) within 48 hours of symptoms could be associated with decreased antibiotic use and hospitalization and improved outcomes.

AB - Background: Patients commonly present to primary care services with upper and lower respiratory tract infections, and guidelines to help physicians investigate and treat acute cough due to suspected pneumonia and influenza are needed. Methods: A systematic search was carried out with eight patient, intervention, comparison, outcome questions related to acute cough due to suspected pneumonia or influenza. Results: There was a lack of randomized controlled trials in the setting of outpatients presenting with acute cough due to suspected pneumonia or influenza who were not hospitalized. Both clinical suggestions and research recommendations were made on the evidence available and CHEST Expert Cough Panel advice. Conclusions: For outpatient adults with acute cough due to suspected pneumonia, we suggest the following clinical symptoms and signs are suggestive of pneumonia: cough; dyspnea; pleural pain; sweating, fevers, or shivers; aches and pains; temperature ≥ 38°C; tachypnea; and new and localizing chest examination signs. Those suspected of having pneumonia should undergo chest radiography to improve diagnostic accuracy. Although the measurement of C-reactive protein levels strengthens both the diagnosis and exclusion of pneumonia, there was no added benefit of measuring procalcitonin levels in this setting. We suggest that there is no need for routine microbiological testing. We suggest the use of empiric antibiotics according to local and national guidelines when pneumonia is suspected in settings in which imaging cannot be performed. Where there is no clinical or radiographic evidence of pneumonia, we do not suggest the routine use of antibiotics. There is insufficient evidence to make recommendations for or against specific nonantibiotic, symptomatic therapies. Finally, for outpatient adults with acute cough and suspected influenza, we suggest that initiating antiviral treatment (according to Centers for Disease Control and Prevention advice) within 48 hours of symptoms could be associated with decreased antibiotic use and hospitalization and improved outcomes.

KW - cough

KW - evidence-based medicine

KW - guidelines

KW - influenza

KW - pneumonia

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