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Postinfectious cough: ACCP evidence-based clinical practice guidelines.

Sidney S Braman

    Chest
    |January 24, 2006
    PubMed
    Summary

    Postinfectious cough, lasting 3-8 weeks after an infection, is common and usually resolves on its own. Early diagnosis of Bordetella pertussis (whooping cough) is crucial for treatment and preventing spread.

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    Area of Science:

    • Pulmonology
    • Infectious Diseases
    • Clinical Practice Guidelines

    Background:

    • Postinfectious cough is a persistent cough (>3 weeks) following an upper respiratory tract infection, lasting up to 8 weeks.
    • Chest radiographs are normal, ruling out pneumonia, and the cough typically resolves spontaneously.
    • This review focuses on diagnosing and treating postinfectious cough, including severe cases caused by Bordetella pertussis.

    Purpose of the Study:

    • To review evidence for diagnosing and treating postinfectious cough.
    • To provide recommendations for clinical practice regarding postinfectious cough.
    • To highlight the diagnosis and management of Bordetella pertussis-related cough.

    Main Methods:

    • Literature search of PubMed from 1950 to August 2004.
    • Included English-language human studies.
    • Search terms included "cough," "postinfectious cough," "postviral cough," "Bordetella pertussis," "pertussis infection," and "whooping cough."

    Main Results:

    • Pathogenesis involves airway inflammation and epithelial disruption, leading to mucus hypersecretion or cough receptor hyperresponsiveness.
    • Antibiotics are generally ineffective unless bacterial sinusitis or early Bordetella pertussis infection is present.
    • Inhaled ipratropium may be beneficial; other causes include upper airway cough syndrome and gastroesophageal reflux disease.
    • Bordetella pertussis infection presents with severe cough, posttussive vomiting, or inspiratory whoop, requiring early antibiotic treatment (macrolides) and isolation.
    • Vaccination against Bordetella pertussis is available and recommended for all ages.

    Conclusions:

    • Postinfectious cough should be considered in patients with a 3-8 week cough and normal chest X-rays.
    • Empiric therapy can be helpful when no specific cause is identified.
    • High suspicion for Bordetella pertussis facilitates early diagnosis, isolation, and antibiotic treatment.

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