@article{fc60377b371347c8a77a095c05b3d144,
title = "Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel Report",
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.",
keywords = "cough, evidence-based medicine, guidelines, influenza, pneumonia",
author = "{CHEST Expert Cough Panel} and Hill, {Adam T.} and Gold, {Philip M.} and {El Solh}, {Ali A.} and Metlay, {Joshua P.} and Belinda Ireland and Irwin, {Richard S.} and Adams, {Todd M.} and Altman, {Kenneth W.} and Elie Azoulay and Barker, {Alan F.} and Birring, {Surinder S.} and Fiona Blackhall and Bolser, {Donald C.} and Boulet, {Louis Philippe} and Braman, {Sidney S.} and Christopher Brightling and Priscilla Callahan-Lyon and Chang, {Anne B.} and Terrie Cowley and Paul Davenport and {El Solh}, {Ali A.} and Patricio Escalante and Field, {Stephen K.} and Dina Fisher and French, {Cynthia T.} and Peter Gibson and Philip Gold and Cameron Grant and Harding, {Susan M.} and Anthony Harnden and Hill, {Adam T.} and Irwin, {Richard S.} and Kahrilas, {Peter J.} and Joanne Kavanagh and Keogh, {Karina A.} and Kefang Lai and Lane, {Andrew P.} and Kaiser Lim and Madison, {J. Mark} and Malesker, {Mark A.} and Stuart Mazzone and Garvey, {Lorcan Mc} and Alex Molasoitis and Abigail Moore and Murad, {M. Hassan} and Mangala Narasimhan and Peter Newcombe and Nguyen, {Huong Q.} and John Oppenheimer and Sonal Singh",
note = "Funding Information: Author contributions: All authors contributed to the design and analysis of the study and writing of the manuscript., Financial/nonfinancial disclosures: The authors have reported to CHEST the following: Although R. S. I. is the Editor in Chief of CHEST, the review and all editorial decisions regarding this manuscript were made independently by others. None declared (A. T. H., P. M. G., A. E. S., J. P. M., B. I.). See alsoe-Table 1., Role of sponsors: CHEST was the sole supporter of these guidelines, this article, and the innovations addressed within., ∗CHEST Expert Cough Panel Collaborators: Todd M. Adams, MD (Webhannet Internal Medicine Associates of York Hospital, Moody, ME), Kenneth W. Altman, MD, PhD (Baylor College of Medicine, Houston, TX), Elie Azoulay, MD, PhD (University of Paris, Paris, France), Alan F. Barker, MD (Oregon Health & Science University, Portland, OR), Surinder S. Birring, MBChB, MD (Division of Asthma, Allergy and Lung Biology, King's College London, Denmark Hill, London, England), Fiona Blackhall, MD, PhD (University of Manchester, Department of Medical Oncology, Manchester, England), Donald C. Bolser, PhD (College of Veterinary Medicine, University of Florida, Gainesville, FL), Louis-Philippe Boulet, MD, FCCP (Institut universitaire de cardiologie et de pneumologie de Qu{\'e}bec, Quebec [IUCPQ], QC, Canada), Sidney S. Braman, MD, FCCP (Mount Sinai Hospital, New York, NY), Christopher Brightling, MBBS, PhD, FCCP (University of Leicester, Glenfield Hospital, Leicester, England), Priscilla Callahan-Lyon, MD (Adamstown, MD), Anne B. Chang, MBBS, PhD, MPH (Royal Children's Hospital, QLD, Australia), Terrie Cowley (The TMJ Association, Milwaukee, WI), Paul Davenport, PhD (Department of Physiological Sciences, University of Florida, Gainesville, FL), Ali A. El Solh, MD, MPH (University at Buffalo, State University of New York, Buffalo, NY), Patricio Escalante, MD, MSc, FCCP (Mayo Clinic, Rochester, MN), Stephen K. Field, MD (University of Calgary, Calgary, AB, Canada), Dina Fisher, MD, MSc (University of Calgary, Respiratory Medicine, Calgary, AB, Canada), Cynthia T. French, PhD, FCCP (UMass Memorial Medical Center, Worcester, MA), Peter Gibson, MBBS (Hunter Medical Research Institute, NSW, Australia), Philip Gold, MD, MACP, FCCP (Loma Linda University, Loma Linda, CA), Cameron Grant, MB ChB, PhD (University of Aukland School of Medicine, Auckland, New Zealand), Susan M. Harding, MD, FCCP (Division of Pulmonary, Allergy and Critical Care Medicine Department of Medicine, University of Alabama at Birmingham, Birmingham, AL), Anthony Harnden, MB ChB, MSc (University of Oxford, Oxford, England), Adam T. Hill, MB ChB, MD (Royal Infirmary and University of Edinburgh, Edinburgh, Scotland), Richard S. Irwin, MD, Master FCCP (UMass Memorial Medical Center, Worcester, MA), Peter J. Kahrilas, MD (Feinberg School of Medicine, Northwestern University, Chicago, IL), Joanne Kavanagh, MBChB (Division of Asthma, Allergy and Lung Biology, King's College London, Denmark Hill, London, England), Karina A. Keogh, MD (Mayo Clinic, Rochester, MN), Kefang Lai, MD, PhD (First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China), Andrew P. Lane, MD (Johns Hopkins University School of Medicine, Baltimore, MD), Kaiser Lim, MD (Mayo Clinic, Rochester, MN), J. Mark Madison, MD, FCCP (UMass Memorial Medical Center, Worcester, MA), Mark A. Malesker, PharmD, FCCP (Creighton University School of Pharmacy and Health Professions, Omaha, NE), Stuart Mazzone, PhD, FCCP (University of Melbourne, VIC, Australia), Lorcan Mc Garvey, MD (The Queen's University Belfast, Belfast, Northern Ireland), Alex Molasoitis, PhD, MSc, RN (Hong Kong Polytechnic University, Hong Kong, China), Abigail Moore, BM BCh (University of Oxford, Oxford, England), M. Hassan Murad, MD, MPH (Mayo Clinic, Rochester, MN), Mangala Narasimhan, DO, FCCP (Hofstra-Northwell Health, Manhasset, NY), Peter Newcombe, PhD (School of Psychology University of Queensland, QLD, Australia), Huong Q. Nguyen, PhD, RN (Kaiser Permanente, Pasadena, CA), John Oppenheimer, MD (University of Medicine and Dentistry of New Jersey-Rutgers University), Mark Rosen, MD, Master FCCP (Icahn School of Medicine at Mount Sinai, New York, NY), Bruce Rubin, MEngr, MD, MBA (Virginia Commonwealth University, Richmond, VA), Richard J. Russell, MBBS (University of Leicester, Glenfield Hospital, Leicester, England), Jay H. Ryu, MD, FCCP (Mayo Clinic, Rochester, MN), Sonal Singh, MD, MPH (UMass Memorial Medical Center, Worcester, MA), Jaclyn Smith, MB ChB, PhD (University of Manchester, Manchester, England), Maeve P. Smith, MB ChB, MD (University of Alberta, Edmonton, AB, Canada), Susan M. Tarlo, MBBS, FCCP (Toronto Western Hospital, Toronto, ON, Canada), Julie Turmel, PhD (Institut universitaire de cardiologie et de pneumologie de Qu{\'e}bec, Quebec [IUCPQ], QC, Canada), Anne E. Vertigan, PhD, MBA, BAppSc (SpPath) (John Hunter Hospital, NSW, Australia), Gang Wang, MD, PhD (Sichuan University, West China Hospital, Chengdu, China), Miles Weinberger, MD, FCCP (University of Iowa Hospitals and Clinics, Iowa City, IA), Endorsements: This guideline has been endorsed by the American Association for Respiratory Care (AARC) and American College of Allergy, Asthma and Immunology (ACAAI)., Other contributions: Education and Clinical Services Librarians working in the University of Massachusetts Medical School Library (Nancy Harger, MLS, and Judy Nordberg, MLS) performed all systematic searches for each patient, intervention, comparison, outcome question., Additional information: Thee-Appendix ande-Table can be found in the Supplemental Materials section of the online article.",
year = "2019",
month = jan,
doi = "10.1016/j.chest.2018.09.016",
language = "English (US)",
volume = "155",
pages = "155--167",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "1",
}