Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel Report

Background: Patients commonly present to primary care services with upperand lower respiratory tract infections, and guidelines to help physiciansinvestigate and treat acute cough due to suspected pneumonia and influenza areneeded.

Methods: A systematic search was carried out with eight patient,intervention, comparison, outcome questions related to acute cough due tosuspected pneumonia or influenza.

Results: There was a lack of randomized controlled trials in thesetting of outpatients presenting with acute cough due to suspected pneumoniaor influenza who were not hospitalized. Both clinical suggestions and researchrecommendations were made on the evidence available and CHEST Expert CoughPanel advice.

Conclusions: For outpatient adults with acute cough due to suspectedpneumonia, we suggest the following clinical symptoms and signs are suggestiveof pneumonia: cough; dyspnea; pleural pain; sweating, fevers, or shivers; achesand pains; temperature ≥ 38°C; tachypnea; and new and localizing chestexamination signs. Those suspected of having pneumonia should undergo chestradiography to improve diagnostic accuracy. Although the measurement ofC-reactive protein levels strengthens both the diagnosis and exclusion ofpneumonia, there was no added benefit of measuring procalcitonin levels in thissetting. We suggest that there is no need for routine microbiological testing.We suggest the use of empiric antibiotics according to local and nationalguidelines when pneumonia is suspected in settings in which imaging cannot beperformed. Where there is no clinical or radiographic evidence of pneumonia, wedo not suggest the routine use of antibiotics. There is insufficient evidenceto make recommendations for or against specific nonantibiotic, symptomatictherapies. Finally, for outpatient adults with acute cough and suspectedinfluenza, we suggest that initiating antiviral treatment (according to Centersfor Disease Control and Prevention advice) within 48 hours of symptoms could beassociated with decreased antibiotic use and hospitalization and improvedoutcomes.