3 Patients who present with other identified factors ( Table 1) should be referred for further evaluation the presence of these alarm symptoms could be indicative of a more serious condition associated with cough, such as pulmonary embolism, pulmonary edema, foreign body inhalation, or status asthmaticus. 11 In addition, patients with underlying and chronic diseases or those who are immunocompromised should be further evaluated. 11 Although there are many similarities with regard to cough in both of these populations, there are also clinical and physiological differences between children and adults, such as adult definitions (e.g., chronic bronchitis and COPD) not recognized as pediatric diagnostic entities in children and differing responses to some medications. The American College of Chest Physicians’ clinical guidelines recommend that patients presenting with cough be divided into children (those younger than 15 years of age) and adults. When evaluating a cough, adults need to be assessed and treated differently than children. 10 This places the pharmacist in a pivotal position to help identify patients who may need further evaluation and help in selecting the most appropriate product. 8 Many patients suffering from cough will seek out self-care options more than $8 billion was spent in 2017 on cough and cold products. 2 Patients may also experience a reduced sense of well-being owing to feelings of self-consciousness, anxiety, musculoskeletal pain, and urinary incontinence. 2,9 In a recent survey, 52% of respondents indicated that cough/cold impacted their daily life a fair amount to a lot, and almost 60% reported cough or nasal congestion as the symptoms making it most difficult to sleep. 1,8 Common etiologies contributing to chronic cough are upper airway cough syndrome, gastroesophageal reflux disease, tobacco use, and angiotensin-converting enzyme inhibitor use.ĭespite the nature of cough, it can be challenging to manage, causing the patient difficulties in performing daily activities and having a significant impact on a patient’s quality of life. 7 Noninfectious causes of acute cough include asthma and chronic obstructive pulmonary disease (COPD) exacerbations, allergic rhinitis, and exposure to environmental pollutants. 6 Most acute coughs are due to upper respiratory tract infections, are self-limiting, and rarely require significant medical intervention. 3-5 Cough is classified based on duration an acute cough is defined as lasting less than 3 weeks, a subacute cough is defined as having a duration between 3 and 8 weeks, and a chronic cough is one that is more than 8 weeks. It is responsible for up to 30 million primary care visits annually and is among the leading reasons for office and emergency department visits. 1,2 Cough is a common complaint for which many patients will seek medical care. C ough is considered an important protective reflex mechanism, helping to clear the airways from excessive secretions and preventing foreign particles from entering the body, but when it compromises the respiratory system, a cough can become excessive, nonproductive, and potentially harmful.
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