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

被引：23

作者：

Hill, Adam T. ^{[1
,2
,32
]}

Gold, Philip M. ^{[3
]}

El Solh, Ali A. ^{[4
,22
]}

Metlay, Joshua P. ^{[5
,6
]}

Ireland, Belinda ^{[7
]}

Irwin, Richard S. ^{[8
,26
]}

Adams, Todd M. ^{[9
]}

Altman, Kenneth W. ^{[10
]}

Azoulay, Elie ^{[11
]}

Barker, Alan F. ^{[12
]}

Birring, Surinder S. ^{[13
]}

Blackhall, Fiona ^{[14
]}

Bolser, Donald C. ^{[15
]}

Boulet, Louis-Philippe ^{[16
]}

Braman, Sidney S. ^{[17
]}

Brightling, Christopher ^{[18
]}

Callahan-Lyon, Priscilla

Chang, Anne B. ^{[19
]}

Cowley, Terrie ^{[20
]}

Davenport, Paul ^{[21
]}

Escalante, Patricio ^{[23
]}

Field, Stephen K. ^{[24
]}

Fisher, Dina ^{[25
]}

French, Cynthia T. ^{[26
]}

Gibson, Peter ^{[27
]}

Gold, Philip ^{[28
]}

Grant, Cameron ^{[29
]}

Harding, Susan M. ^{[30
]}

Harnden, Anthony ^{[31
]}

Kahrilas, Peter J. ^{[33
]}

Kavanagh, Joanne ^{[13
]}

Keogh, Karina A. ^{[23
]}

Lai, Kefang ^{[34
]}

Lane, Andrew P. ^{[35
]}

Lim, Kaiser ^{[23
]}

Madison, J. Mark ^{[26
]}

Malesker, Mark A. ^{[36
]}

Mazzone, Stuart ^{[37
]}

Mc Garvey, Lorcan ^{[38
]}

Molasoitis, Alex ^{[39
]}

Moore, Abigail ^{[31
]}

Murad, M. Hassan ^{[23
]}

Narasimhan, Mangala ^{[40
]}

Newcombe, Peter ^{[41
]}

Nguyen, Huong Q. ^{[42
]}

Oppenheimer, John ^{[43
]}

Rosen, Mark ^{[44
]}

Rubin, Bruce ^{[45
]}

Russell, Richard J. ^{[18
]}

Ryu, Jay H. ^{[23
]}

机构：

[1] Royal Infirm, Dept Resp Med, 51 Little France Crescent, Edinburgh EH16 4SA, Midlothian, Scotland

[2] Univ Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Midlothian, Scotland

[3] Loma Linda Univ, Sch Med, Loma Linda, CA 92350 USA

[4] SUNY Buffalo, Univ Buffalo, Buffalo, NY USA

[5] Massachusetts Gen Hosp, Boston, MA 02114 USA

[6] Harvard Med Sch, Boston, MA USA

[7] The EvidenceDoc, Pacific, MO USA

[8] Univ Massachusetts, Mem Med Ctr, Worcester, MA 01605 USA

[9] Webhannet Internal Med Associates York Hosp, Moody, ME USA

[10] Baylor Coll Med, Houston, TX 77030 USA

[11] Univ Paris, Paris, France

[12] Oregon Hlth & Sci Univ, Portland, OR 97201 USA

[13] Kings Coll London, Div Asthma Allergy & Lung Biol, Denmark Hill, London, England

[14] Univ Manchester, Dept Med Oncol, Manchester, Lancs, England

[15] Univ Florida, Coll Vet Med, Gainesville, FL USA

[16] Inst Univ Cardiol & Pneumol Quebec, Quebec Iucpq, PQ, Canada

[17] Mt Sinai Hosp, New York, NY 10029 USA

[18] Univ Leicester, Glenfield Hosp, Leicester, Leics, England

[19] Royal Childrens Hosp, Brisbane, Qld, Australia

[20] TMJ Assoc, Milwaukee, WI USA

[21] Univ Florida, Dept Physiol Sci, Gainesville, FL 32610 USA

[22] Univ Buffalo State Univ New York, Buffalo, NY USA

[23] Mayo Clin, Rochester, MN USA

[24] Univ Calgary, Calgary, AB, Canada

[25] Univ Calgary, Resp Med, Calgary, AB, Canada

[26] UMass Mem Med Ctr, Worcester, MA USA

[27] Hunter Med Res Inst, New Lambton Hts, NSW, Australia

[28] Loma Linda Univ, Loma Linda, CA 92350 USA

[29] Univ Aukland, Sch Med, Auckland, New Zealand

[30] Univ Alabama Birmingham, Dept Med, Div Pulm Allergy & Crit Care Med, Birmingham, AL 35294 USA

[31] Univ Oxford, Oxford, England

[32] Royal Infirm, Edinburgh, Midlothian, Scotland

[33] Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA

[34] Guangzhou Med Univ, Affiliated Hosp 1, Guangzhou, Guangdong, Peoples R China

[35] Johns Hopkins Univ, Sch Med, Baltimore, MD USA

[36] Creighton Univ, Sch Pharm & Hlth Profess, Omaha, NE 68178 USA

[37] Univ Melbourne, Melbourne, Vic, Australia

[38] Queens Univ Belfast, Belfast, Antrim, North Ireland

[39] Hong Kong Polytech Univ, Hong Kong, Peoples R China

[40] Hofstra Northwell Hlth, Manhasset, NY USA

[41] Univ Queensland, Sch Psychol, Brisbane, Qld, Australia

[42] Kaiser Permanente, Pasadena, CA USA

[43] Univ Med & Dent New Jersey Rutgers Univ, Newark, NJ USA

[44] Icahn Sch Med Mt Sinai, New York, NY 10029 USA

[45] Virginia Commonwealth Univ, Richmond, VA USA

[46] Univ Manchester, Manchester, Lancs, England

[47] Univ Alberta, Edmonton, AB, Canada

[48] Toronto Western Hosp, Toronto, ON, Canada

[49] John Hunter Hosp, New Lambton Hts, NSW, Australia

[50] Sichuan Univ, West China Hosp, Chengdu, Sichuan, Peoples R China

来源：

CHEST | 2019年 / 155卷 / 01期

基金：

英国惠康基金;

关键词：

cough; evidence-based medicine; guidelines; influenza; pneumonia; COMMUNITY-ACQUIRED PNEUMONIA; RESPIRATORY-TRACT INFECTION; C-REACTIVE PROTEIN; PRIMARY-CARE; RADIOGRAPHS; PREDICTION; MANAGEMENT; HISTORY; TOOL;

D O I：

10.1016/j.chest.2018.09.016

中图分类号：

R4 [临床医学];

学科分类号：

100218 [急诊医学];

摘要：

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 degrees 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.

引用

页码：155 / 167

页数：13

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