CHEST Guidelines-Adult-Outpatients-With-Acute-Cough-Due-to-Suspecte (1)

Adult-Outpatients-With-Acute-Cough-Due-to-Suspecte (1)

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In a comprehensive report, the CHEST Expert Cough Panel offers guidelines for managing adult outpatients with acute cough suspected to be due to pneumonia or influenza. Given the common presentation of upper and lower respiratory tract infections in primary care, the guidelines address the need for accurate diagnosis and effective treatment strategies.<br /><br />The report, derived through systematic evidence collection, highlights the paucity of randomized controlled trials on outpatient adults with such acute conditions. It suggests that for suspected pneumonia in outpatient adults, specific symptoms such as cough, dyspnea, pleural pain, and fever above 38°C may indicate pneumonia. The use of chest radiography is recommended to enhance diagnostic precision, while measurement of C-reactive protein (CRP) can support diagnosis. Procalcitonin level measurement is deemed unnecessary as it doesn’t add diagnostic value.<br /><br />The guidelines discourage routine microbiological testing for community-acquired pneumonia (CAP) unless test results could alter therapeutic decisions. If chest imaging is unavailable, the use of empiric antibiotics, aligned with local/national guidelines, is suggested. Conversely, antibiotics are not recommended in the absence of clinical or radiographic evidence of pneumonia.<br /><br />For suspected influenza, initiating antiviral treatment within 48 hours is advised as it may reduce antibiotic use, hospitalizations, and improve outcomes. The guidelines underline the significant health burden of pneumonia and influenza, which are major infectious causes of mortality in the U.S., emphasizing the importance of correct management in minimizing unnecessary antibiotic use and enhancing patient outcomes.<br /><br />Future areas for research include evaluating the practicality and cost-effectiveness of these guidelines, developing better diagnostic algorithms, and conducting randomized controlled trials on pathogen-directed treatment and nonantibiotic therapies.

Keywords

acute cough

pneumonia

influenza

diagnosis

treatment strategies

chest radiography

C-reactive protein

antiviral treatment

antibiotic use

respiratory infections