Holzinger Felix, Gehrke-Beck Sabine, Krüger Karen
Dtsch Med Wochenschr. 2022 Aug;147(15):989-1001. doi: 10.1055/a-1716-8101. Epub 2022 Aug 1.
Cough is a frequent reason for consultation in the general practitioner's office. Most of the time, the symptom is harmless and self-limiting, as in the case of a banal cold cough, for example - however, serious diseases such as malignancies can also be the cause. Evaluation is therefore not always easy. This article presents a targeted and appropriate approach and discusses which treatments are recommended and effective.Acute and chronic cough are differentiated according to the duration of symptoms (up to 8 weeks/longer than 8 weeks). The most common cause of acute cough is a self-limiting viral infection of the upper respiratory tract; the most important differential diagnosis is community-acquired pneumonia. If there are no defined warning signs (red flags), the history and clinical examination are sufficient to establish the diagnosis in the case of an acute cough; medication is not necessary. In the case of a chronic cough, a chest X-ray is usually ordered and then further investigations are carried out in accordance with the most probable suspected diagnosis; probationary therapies are an important part of the workup. Coughs that are refractory to treatment or unexplained require individualised treatment (pharmacological, including off-label, non-pharmacological) and regular re-evaluation.
咳嗽是患者前往全科医生诊所就诊的常见原因。大多数情况下,该症状并无大碍且具有自限性,比如普通感冒咳嗽就是如此——然而,诸如恶性肿瘤等严重疾病也可能是病因。因此,评估并非总是易事。本文介绍了一种有针对性且恰当的方法,并探讨了哪些治疗方法是推荐的且有效的。急性咳嗽和慢性咳嗽根据症状持续时间(长达8周/超过8周)来区分。急性咳嗽最常见的病因是上呼吸道自限性病毒感染;最重要的鉴别诊断是社区获得性肺炎。如果没有明确的警示信号(危险信号),对于急性咳嗽,病史和临床检查足以确诊;无需用药。对于慢性咳嗽,通常会进行胸部X光检查,然后根据最可能的疑似诊断进行进一步检查;试验性治疗是检查过程的重要组成部分。难治性或不明原因的咳嗽需要个体化治疗(药物治疗,包括超说明书用药、非药物治疗)并定期重新评估。