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

Adam T. Hill, Philip M. Gold, Ali A. El Solh, Joshua P. Metlay, Belinda Ireland, Richard S. Irwin, CHEST Expert Cough Panel

Research output: Contribution to journalArticleResearchpeer-review

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.

LanguageEnglish
Number of pages13
JournalChest
DOIs
StateE-pub ahead of print - 6 Oct 2018
Externally publishedYes

Fingerprint

Cough
Human Influenza
Pneumonia
Outpatients
Guidelines
Anti-Bacterial Agents
Tachypnea
Pain
Sweating
Calcitonin
Respiratory Tract Infections
Dyspnea
Signs and Symptoms
Antiviral Agents
Primary Health Care
Hospitalization
Fever
Randomized Controlled Trials
Temperature
Proteins

Cite this

Hill, A. T., Gold, P. M., El Solh, A. A., Metlay, J. P., Ireland, B., Irwin, R. S., & CHEST Expert Cough Panel (2018). Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel Report. Chest. DOI: 10.1016/j.chest.2018.09.016
Hill, Adam T. ; Gold, Philip M. ; El Solh, Ali A. ; Metlay, Joshua P. ; Ireland, Belinda ; Irwin, Richard S. ; CHEST Expert Cough Panel. / Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza : CHEST Guideline and Expert Panel Report. In: Chest. 2018
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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.",
author = "Hill, {Adam T.} and Gold, {Philip M.} and {El Solh}, {Ali A.} and Metlay, {Joshua P.} and Belinda Ireland and Irwin, {Richard S.} and {CHEST Expert Cough Panel}",
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Hill, AT, Gold, PM, El Solh, AA, Metlay, JP, Ireland, B, Irwin, RS & CHEST Expert Cough Panel 2018, 'Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel Report' Chest. DOI: 10.1016/j.chest.2018.09.016

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, 06.10.2018.

Research output: Contribution to journalArticleResearchpeer-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 - 2018/10/6

Y1 - 2018/10/6

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

JO - Chest

JF - Chest

SN - 0012-3692

ER -

Hill AT, Gold PM, El Solh AA, Metlay JP, Ireland B, Irwin RS et al. Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel Report. Chest. 2018 Oct 6. Available from, DOI: 10.1016/j.chest.2018.09.016