How to distinguish an initial cough?

From the Guidelines

Distinguishing initiative cough involves recognizing when a cough is voluntary rather than reflexive, and the most effective approach is to evaluate and treat for the common causes of cough using a combination of selected diagnostic tests and empiric therapy, as recommended by the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines 1. To identify initiative cough, observe if the cough appears purposeful and controlled rather than spontaneous. Initiative cough typically has a more regular pattern and may be preceded by a preparatory breath. The person can usually stop the cough when asked, unlike reflexive coughs triggered by irritants or illness. Some key points to consider when evaluating cough include:

• The medical history and physical examination are essential in determining the cause of cough, although the timing and characteristics of the cough are of little diagnostic value 1.
• In patients with chronic cough, systematically direct empiric treatment at the most common causes of cough, such as upper airway cough syndrome (UACS), asthma, nonasthmatic eosinophilic bronchitis (NAEB), and gastroesophageal reflux disease (GERD) 1.
• Therapy should be given in sequential and additive steps because more than one cause of cough may be present 1.
• Patients with chronic cough who smoke should be counseled and assisted with smoking cessation, and those receiving an ACE inhibitor should have the drug stopped and replaced 1.
• Initial empiric treatment should begin with an oral first-generation antihistamine/decongestant, and the possibility of asthma should be worked up next if the cough persists after treatment for UACS 1. It is essential to note that the approach to cough management should be tailored to the individual patient, taking into account their medical history, physical examination, and diagnostic test results. By following the ACCP guidelines and using a systematic and integrated approach, healthcare providers can effectively diagnose and manage cough, improving patient outcomes and quality of life.

From the FDA Drug Label

WARNINGS Ask a doctor before use if you have cough that occurs with too much phlegm (mucus) cough that lasts or is chronic such as occurs with smoking, asthma, chronic bronchitis, or emphysema Warnings ... Ask a doctor before use if you have • chronic cough that lasts as occurs with smoking, asthma or emphysema • cough that occurs with too much phlegm (mucus)

The FDA drug label does not answer the question.

From the Research

Distinguishing Initiative Cough

To distinguish initiative cough, it is essential to understand the various causes of cough and the appropriate diagnostic approaches. The following points highlight the key considerations:

• Chronic cough, defined as a cough lasting more than eight weeks in adults and more than four weeks in children, requires a thorough evaluation, including a focused history, physical examination, and chest radiography 2.
• The most common causes of chronic cough in adults are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, which can be diagnosed through a combination of clinical evaluation, empiric therapy, and further testing if necessary 2.
• In children, the most common causes of chronic cough are respiratory tract infections, asthma, and gastroesophageal reflux disease, and evaluation should include chest radiography and spirometry 2.
• Acute cough due to upper respiratory infections can be challenging to treat, and there is limited evidence to support the efficacy of commonly used therapeutic agents, such as narcotics and over-the-counter oral antitussives and expectorants 3.
• Alternative treatments, such as honey and topically applied vapor rubs, may be effective in relieving acute cough symptoms in children 3.
• The antitussive efficacy of dextromethorphan, a commonly used over-the-counter cough medication, has been questioned, with some studies showing little to no significant difference in cough severity compared to placebo 4.
• Benzonatate and guaifenesin, either alone or in combination, have been shown to inhibit cough-reflex sensitivity and may be effective in treating acute viral cough 5.
• Guaifenesin, a mucoactive drug, has a well-established role in the management of chronic bronchitis and upper respiratory tract infections, acting by loosening mucus in the airways and making coughs more productive 6.