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Other similar respiratory conditions
  • Common cold:
    • Symptoms: Stuffy or runny nose, sneezing, coughing, sore throat, watery eyes, low-grade fever, achy muscles and bones, headache, mild fatigue.
  • Allergic rhinitis:
    • Symptoms: Similar symptoms to that of common cold but no fever and more optical symptoms presence.
  • To know more of the symptoms of common respiratory diseases, Click here
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Recommendation: Look for other differential diagnosis

Recommendation: Require medical referral

Rational:

  • Risk of airway obstruction: A foreign object can partially or completely block the airway. This can lead to:
  • Severe respiratory distress: Difficulty breathing, gasping, wheezing, and cyanosis (bluish discoloration of the skin)
  • Choking: Complete obstruction can lead to choking, which is a life-threatening emergency requiring immediate intervention.
  • Potential for damage: A sharp or irregularly shaped object can damage the delicate tissues of the airway or lungs.
  • Risk of migration: If not promptly removed, the object can move further down the respiratory tract, leading to complications like pneumonia or lung abscess.
  • Need for specialized procedures: Removing a foreign object from the airway often requires specialized procedures like bronchoscopy (inserting a flexible tube with a camera and instruments) that can only be performed by trained medical professionals.

Recommendation: Require medical referral

Rational:  Non-prescription cough medication are not labelled for self medication for children less than 4 years

Recommendation: Require medical referral

Rational: 
  • Persistent cough can indicate a more serious underlying condition: While a cough associated with a common cold is typically self-limiting and resolves within 1-2 weeks, a persistent cough may be a symptom of various other respiratory or non-respiratory illnesses.
  • Possible underlying conditions:
    • Postnasal drip: Post nasal drip is a cause of cough, if it persists, further evaluation may be needed to identify underlying allergies or sinusitis.
    • Asthma: Cough can be a primary symptom of asthma, and if it persists, it may indicate poorly controlled asthma.
    • GERD (Gastroesophageal reflux disease): Stomach acid refluxing into the esophagus can cause a chronic cough.
    • Chronic bronchitis: A long-term inflammatory condition of the bronchial tubes.
    • Whooping cough: A highly contagious bacterial infection that causes severe coughing fits.
    • Tuberculosis: A bacterial infection that typically affects the lungs.
    • Lung cancer: In some cases, a persistent cough can be a sign of lung cancer.

Recommendation: Require medical referral

Rational:  A SpO2 of 94% in someone with cold symptoms should prompt careful consideration. It's a sign that the respiratory system might be more significantly affected than in a typical cold. The person's baseline: If their normal SpO2 is usually 98-100%, then 94% is a bigger drop than if their baseline is normally 95%. If the 94% is accompanied by shortness of breath, chest pain, confusion, or blue lips, it's a clear indication for medical help. Underlying conditions: People with pre-existing lung or heart conditions are at higher risk and should seek medical advice with a 94% reading.

Recommendation: Require medical referral

Rational:  T>100.4F is a risk factor for community-acquired pneumonia. Fever with URTI defined an temperature > 100F is more common in children than adults but usually resolves in 2 to 3 days

Recommendation: Require medical referral

Rational: 
  • Masking a Serious Symptom: In conditions like TB, lung cancer, or even worsening heart failure, a cough is a significant indicator of the disease's activity or progression. Self-treating the cough can mask this crucial warning sign, delaying proper diagnosis and treatment.
  • Increased Risk of Complications: Respiratory Conditions (Asthma, COPD): A cough in these cases might signal a dangerous flare-up or infection that needs immediate medical management (e.g., steroids, antibiotics). Self-treatment can lead to severe breathing difficulties.
  • Heart Conditions (CHF): A cough can be a symptom of fluid buildup in the lungs due to heart failure. Self-treating with cough suppressants might hide this and worsen the heart condition.
  • Altered Immune Response: In conditions like HIV infection or cancer (especially during treatment), the immune system is compromised. A cough could indicate a secondary infection that requires prompt, targeted treatment, not just over-the-counter cough medicine.
  • Disease-Specific Interactions: Some cough medications can interact with drugs used to treat the underlying conditions (e.g., heart medications, HIV medications).

Recommendation: Require medical referral

 
Rational:  Dyspnea (shortness of breath): Dyspnea indicates the lower respiratory tract (lungs) may be involved, suggesting conditions like pneumonia, bronchitis, asthma exacerbation, or even heart failure.
Rational:  Chest pain: Chest pain is rarely a symptom of a cough. It can indicate cardiac issues (angina), pneumonia, pleurisy (inflammation of the lung lining), or other serious conditions.
Rational:  Cold, pale, clammy skin: This suggests poor perfusion and the body's attempt to shunt blood to vital organs. It can be a sign of shock, severe infection, or a cardiac event.
Rational:  Altered sensorium: Confusion, disorientation, or decreased alertness indicates that the brain isn't getting enough oxygen or there's a systemic issue (severe infection, etc.) affecting brain function.
Rational:  Unable to swallow: Being unable to swallow suggests a severe infection (tonsillitis, abscess), epiglottitis (inflammation of the epiglottis), or another condition obstructing the throat.
Rational:  Cyanosis: Bluish discoloration of the skin or lips signifies severe hypoxemia (low blood oxygen levels). This is a critical sign of impaired respiratory function. It can be seen in severe asthma, COPD, or heart failure.
Rational:  Hemoptysis (coughing up blood): This is never a symptom of a simple cough. It suggests a serious underlying condition such as tuberculosis, lung cancer, pulmonary embolism, or severe bronchitis.
Rational:  Weight loss: Significant, unintentional weight loss is not typical of a cough. It can be a sign of chronic conditions like cancer, tuberculosis, or other chronic infections.
Rational:  Night sweats: True night sweats (drenching sweating requiring a change of clothes/linens) are more indicative of tuberculosis, other infections, or even malignancy.
Rational:  Peripheral edema (swelling in extremities): It often points to heart failure, kidney disease, or other systemic issues.
Rational:  Enlarged lymph nodes: Significantly enlarged or persistently enlarged nodes suggest a more widespread infection or even malignancy.

Recommendation: Pharmacological and non-pharmacological therapy

  Non-pharmacological therapy  
  • Hydration: Drinking plenty of fluids, especially water, is crucial for both types of cough. It thins mucus, making it easier to cough up.
  • Humidification with cool mist vaporizers or steamy showers. It helps moisten and loosen secretions. Cool-moist humidifier preferred over hot-water vaporizers
  • Rest: While not directly targeting the cough, rest is essential for the body to recover from the underlying illness that's causing the cough.
  • Steam inhalation: Inhaling steam can help loosen mucus in the airways.
  • Controlled coughing: Deep breathing followed by forceful coughing can help clear mucus from the lungs.
  • Upright positioning: Keeping the upper body elevated can help prevent mucus from pooling in the throat and triggering coughs. Upright positioning enhance nasal drainage, which can help with coughs caused by postnasal drip.
  • Saline nasal rinses: While primarily for nasal congestion, saline rinses can help clear postnasal drip, which can trigger a productive cough.
  • Some cough formulations contain alcohol, avoid during pregnancy
  • nonmedicated lozenges and hard candies may reduce cough by stimulating saliva, thereby decreasing throat irritation
  • Honey and lemon helps the symptoms
  Pharmacological therapy
  • Expectorant (Guaifenesin)
    • Dose
      • Adults: 200-400 mg every 4 hours or 600-1200 mg every 12 hours (maximum 2400 mg/day)
      • Children: Dosage varies by age; consult product labeling
    • A/E and caution
      • generally well tolerated. A/e include n/v, dizziness, headache, rash, diarrhea, drowsiness, stomach pain.
      • large doses have been associated with renal calculi.
      • Do not take more frequently or in higher doses than recommended.
    • Remarks: Staying well hydrated while taking expectorants can help the product to thin secretions
  • Antitussive if cough affects sleep or work. Reevaluate in 7 days
 

Recommendation: Pharmacological and non-pharmacological therapy

  Non-pharmacological therapy  
  • Hydration: Drinking plenty of fluids, especially water, is crucial for both types of cough. It can soothe an irritated throat.
  • Humidification with cool mist vaporizers or steamy showers. It can soothe a dry, irritated throat.
  • Rest: While not directly targeting the cough, rest is essential for the body to recover from the underlying illness that's causing the cough.
  • Throat lozenges: While some contain local anesthetics, even simple lozenges can soothe an irritated throat and reduce the urge to cough.
  • Honey: Honey has demulcent properties and can soothe the throat.
  • Warm beverages: Warm liquids like tea or broth can also be soothing for a dry cough.
  • Tea with lemon and honey and hot broths as soothing and increasing fluid intake.
  Pharmacological therapy
  • Antitussives: Act on the central nervous system to raise the cough threshold.
    • Codeine: Codeine is a controlled substance and has potential for abuse.
      • Dose
        • Adults: 10-20 mg every 4-6 hours (maximum 120 mg/day)
        • Children: Dosage varies by age; consult product labeling
      • A/E and caution

        • nausea, vomiting, sedation, dizziness and constipation

        • Avoid during pregnancy, breastfeeding

      • Remarks
        • Decrease respiratory drive can occur in patients with impaired respiratory reserve (asthma, COPD) or preexisting respiratory depression; drug addicts and who take other respiratory depressants or sedatives, including alcohol, hence should use with caution.
    • Dextromethorphan
      • Dose:
        • Adults: 10-20 mg every 4-8 hours or 30 mg every 8 hours (maximum 120 mg/day)
        • Children: Dosage varies by age; consult product labeling
      • A/E and caution
        • A/E uncommon with usual dose but may include drowsiness, n/v, stomach discomfort, or constipation
        • overdose symptoms: confusion, excitation, nervousness, irritability, restlesness and drowsiness, as well as severe n/v.
        • Respiratory depression may occur with very high dose.
        • CI in patients receiving concomitant MAOIs and for 2 weeks after discontinuation because of the risk of serotenorgic syndrome
      • Remarks
        • Can be used in pregnancy
    • Diphenhydramine: While primarily an antihistamine, its anticholinergic and sedative effects can help suppress cough, especially coughs that interfere with sleep.
      • Dose: Typically, 25 to 50 mg every 4 to 6 hours as needed. Maximum daily dose is usually 300 mg.
      • A/E and caution:
        • CI: new borns and premature infants, children (paradoxical excitation rather than sedation and also have safety issues), frail elderly, Narrow angle glaucoma, acute asthma exacerbation, stenosing peptic ulcer, BPH, bladder neck and pyloroduodenal obstruction, hyperthyroidism, CV disease
        • 1st Gen A/E: CNS depression (e.g., sedation, impaired performance) and anticholinergic effects (e.g., dry eyes, mouth, nose, vagina; blurred vision; urinary hesitancy and retention; constipation; and reflex tachycardia), respiratory depression
        • Some 1st gen are photosensitizing and require use of sunscreen or protective clothing
        • Avoid in lactating mothers (pass to breast milk)- short acting chloramphenicol, fexofenadine or loratadine are the best option if oral antihistamines is needed. Take the antihistamine ar bedtime after last feeding of the day
        • 1st gen avoid in children (paradoxical excitation as well as safety issues)
      • Remarks:
        • May be helpful in nocturnal cough
    • Chlophedianol: Suppresses the cough reflex in the brain.
      • Dose: The usual dose is 25mg three to four times a day.
      • A/E and caution:
        • excitation, hyperirritability, nightmares, hallucinations, hypersensitivity, and urticaria.
        • At large doses: dry mouth, vertigo, visual disturbances, n/v, and drowsiness.
  • Drug interactions
    • Codeine
      • CNS depressants including alcohol, benzodiazepines, sedating antihistamines, antipsychotics, anxiolytic agents, cannabidiol
        • both enhance CNS depressant effect of each other
        • avoid
      • Strong CYP2D6 inhibitors (e.g., bupripion, fluoxetine, paroxetine, quinidine)
        • Reduced metabolism of codeine to active metabolite and hence reduced effect
        • avoid
      • Strong CYP3A4 inducers (e.g., rifampin, phenytoin)
        • increased metabolism to active metabolite and hence enhanced effect.
        • avoid
      • mixed agonist/antagonist (e.g., buprenorphine)
        • reduced codeine effect
        • avoid
      • naltroxone
        • reduced codeine effect
        • avoid
    • Dextromethorphan
      • Strong CYP2D6 inhibitors (e.g., bupripion, fluoxetine, paroxetine, quinidine)
        • reduced metabolism leads to increased psychoactive effect of dextromethorphan
        • avoid
      • Serotonin reuptake inhibitors (citalopram, escitalopram, fluoxetine, sertraline)
        • increase the risk of serotonergic (psychoactive) effect of dextromethorphan
        • avoid
      • MAOIs
        • increased dextromethorphan-associated serotonergic adverse effects.
        • avoid
  Reevaluate in 7 days  
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