1. How long? Otherwise well? Diurnal pattern?
Cough
How long?
Otherwise well?
Diurnal pattern?

2. How long? Sudden - ? Foreign body Days - infection
Weeks – bronchitis/pneumonia/TB/cancer
Months/years – chronic bronchitis/reflux
Variable - asthma

3. Otherwise well? URT symptoms? Productive of sputum/blood?
Breathless/wheeze?
Systemic upset?
Reflux?
Risk?

4. Diurnal pattern Nocturnal? Exertional? Change of air? Talking/singing?
Meals?

5. Causes URT Extrinsic – FB, air, smoke, ACE inhibitor
Lung infection/damage/allergy/cancer
Reflux

6. Chest X-Ray Haemoptysis (unless obvious cause)
Longer than 3 weeks (unless clearly improving)
Other ‘red flag’
Pain/wt loss/sob/chest signs/hoarse/clubbed
Abnormal in most cases of TB/cancer

7. Infection

8. Infection Acute URT viral - days Acute bronchits – weeks
Pneumonia/pleural infection – months

9. Antibiotic treatment Acute bronchitis
Healthy chest – probably not indicated
Chronic chest – if 2/3 of
More sputum, darker colour, sob.
Little evidence to prefer a particular agent:-
Doxycycline/amoxicillin/macrolide/quinolone

10. Pneumonia CRB65 score Confusion Respiratory rate (over 30)
Blood pressure <90/<60
65 or older

11. C(U)RB65 score 0-1 <3% die Home OK 2 9% die Hospital
3-5 >15% ?ICU
Review if not admitted

12. Pneumonia - treatment Plenty fluids Amoxicillin 500mg tds
Doxycycline/Clarithromycin