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.
| Language | English |
|---|---|
| Pages | 155-167 |
| Number of pages | 13 |
| Journal | Chest |
| Volume | 55 |
| Issue number | 1 |
| Early online date | 6 Oct 2018 |
| DOIs | |
| Publication status | Published - Jan 2019 |
| Externally published | Yes |
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Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza : CHEST Guideline and Expert Panel Report. / Hill, Adam T.; Gold, Philip M. ; El Solh, Ali A.; Metlay, Joshua P.; Ireland, Belinda ; Irwin, Richard S.; CHEST Expert Cough Panel.
In: Chest, Vol. 55, No. 1, 01.2019, p. 155-167.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza
T2 - Chest
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 - CHEST Expert Cough Panel, null
PY - 2019/1
Y1 - 2019/1
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.
U2 - 10.1016/j.chest.2018.09.016
DO - 10.1016/j.chest.2018.09.016
M3 - Article
VL - 55
SP - 155
EP - 167
JO - Chest
JF - Chest
SN - 0012-3692
IS - 1
ER -