HFHT's Choosing Wisely Newsletter
For the whole healthcare team.
Issue 67: Coughing Illness
As we head into another season of viruses, it is important to remember good antibiotics stewardship. Mathematical modelling has shown that by the year 2050, if we continue as we are now, more people will die world-wide from antibiotic-resistant infections than cancer.
In continuing with our current theme, we will explore coughing illness next.

Young woman presents to clinic because she is tired of coughing for the last 2 weeks
  • Coughing mainly at night, disturbs her sleep.
  • Prior history of runny nose and sore throat at the beginning but resolved.


  • Looks tired but well.
  • Temperature 36.6C.
  • Respiratory rate - normal. No tachycardia.
  • Lung examination: wheezes and a bit of crackles right lower lobe.

Does this patient require further investigation?
When to Order a Chest X-Ray

If you think this might be pneumonia:

• Unless impossible in your setting, you should do a chest x-ray to confirm the presence of a new consolidation.
• Crackles +/- wheezes are not adequate to determine if there is pneumonia. What has a better correlation with pneumonia is egophony and asymmetric chest expansion.

But remember...

  • If there is no vital signs abnormalities and a normal lung exam, you most likely don’t need a chest x-ray.
  • In these cases pneumonia is quite rare.

COPD Exacerbation:

You should not consider antibiotics unless there is a clear increase in sputum purulence AND :
  1. Increase in sputum volume AND/OR;
  2. Increased dyspnea.

Adapted from Using Antibiotics Wisely slides courtesy of Choosing Wisely Canada
The Viral Prescription and the Delayed Prescription are downloadable in custom format for Telus, Oscar and Accuro directly from Choosing Wisely Canada .  
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