Practical Case Study of Large AI Models in Medical Diagnosis and Prescription
Yucong Duan
Benefactor: Shiming Gong
International Standardization Committee of Networked DIKWP for Artificial Intelligence Evaluation(DIKWP-SC)
World Artificial Consciousness CIC(WAC)
World Conference on Artificial Consciousness(WCAC)
(Email: duanyucong@hotmail.com)
1Clinical Assessment Report: Case Overview
Patient: A 48-year-old male with no history of asthma, allergic rhinitis, or gastroesophageal reflux disease. Recently experienced persistent cough for about 1 week, with symptoms being more severe at night and during naps, and slightly milder during the day. However, the nighttime cough significantly affected sleep. At the onset of the illness, there was a brief period of hoarseness (aphonia), which has now recovered. Initially, the sputum was abundant and viscous, with a yellow-green purulent appearance. After taking cold medicine (999 Cold Remedy) on his own, the symptoms did not improve. Subsequently, after taking the antibiotic Cefaclor orally for 3 consecutive days, the sputum volume significantly decreased, and the cough was somewhat relieved. The patient felt an itchy throat and a sensation of irritation in the trachea (irritative cough), especially at night. Additionally, for the past 4 days, he has experienced night sweats (sweating that soaks through clothes and bedding after falling asleep), but there were no fever symptoms. He occasionally had brief episodes of chest tightness and shortness of breath, but no significant wheezing. There was no recent history of obvious exposure to allergens. The above symptoms are showing a gradual trend of improvement.
2Preliminary Diagnosis
Most likely diagnosis: Acute tracheobronchitis (acute bronchitis). Based on the patient’s disease course and symptom presentation, it is considered to be an inflammation of the tracheobronchial mucosa caused by an acute respiratory tract infection, accompanied by acute cough and sputum symptoms. The patient initially may have had an upper respiratory tract viral infection (indicated by cold symptoms and aphonia), followed by a bronchial inflammatory response and secondary bacterial infection (indicated by purulent sputum). Acute bronchitis is commonly seen after a common cold, induced by viral infections, and is mostly a self-limiting process. However, purulent sputum often suggests a combined bacterial infection. In this case, the patient’s sputum was viscous and yellow-green, and the symptoms improved after antibiotic treatment, supporting the diagnosis of acute bronchitis with a bacterial infection component. The patient has no history of chronic respiratory diseases, and there were no clear signs of asthma or allergies before or after the onset of the disease, thus not supporting an acute exacerbation of chronic cough diseases (such as cough-variant asthma, chronic rhinosinusitis, etc.), but rather fitting the characteristics of acute infectious bronchitis.
It should be emphasized that the patient’s current cough duration is only about 7 days, which falls within the category of acute cough (
3 weeks). Acute bronchitis is one of the most common causes of acute cough. The duration and clinical manifestations of this case are consistent with the features of acute bronchitis: sudden onset, short disease course with a gradual improvement trend, mild systemic symptoms (no high fever, only night sweats) that disappeared within a few days, and the remaining symptoms are mainly cough and sputum. If there are no obvious abnormal signs on chest examination (no fixed moist rales or localized consolidation signs heard), it supports bronchitis rather than pulmonary consolidation lesions. In summary, based on the current information, acute tracheobronchitis is the most likely diagnostic conclusion.
3Diagnostic Basis and Differential Diagnosis
To clarify the diagnosis, we need to differentiate this case from other possible diseases, focusing on the distinction between acute bronchitis and post-infectious cough (PIC) and considering whether there is a need for further examination for pneumonia.
3.1Cough Duration Classification
Firstly, based on the duration of cough, it can be divided into three categories: acute cough (
3 weeks), subacute cough (3–8 weeks), and chronic cough (
8 weeks). This classification helps to identify the possible causes of cough. Acute bronchitis usually presents as an acute cough duration, while post-infectious cough falls within the subacute cough category, often lasting for several weeks after the initial infection has improved.
Differentiation Points between Acute Tracheobronchitis and Post-infectious Cough
Differentiation Points |
Acute Tracheobronchitis |
Post-infectious Cough (PIC) |
Duration of Illness |
|
3–8 weeks, subacute cough |
Etiology/Cause |
Often directly caused by acute respiratory tract infection, mostly viral, with a minority having secondary bacterial infection |
Caused by residual airway inflammation or hyperreactivity after the previous upper respiratory tract infection, commonly seen in the recovery phase of viral infections |
Clinical Symptoms |
Cough may be accompanied by sputum, which is viscous or purulent (in case of bacterial infection); fever and fatigue may occur at the onset, but usually improve within a few days; cough/sputum may gradually subside after 2–3 weeks |
Mainly residual irritative cough, with little sputum, mostly mucoid sputum or dry cough; acute phase symptoms have disappeared, no fever or other systemic manifestations; irritative cough at night or after exercise is significant, belonging to post-infectious airway hyperreactivity; most cases of cough can resolve spontaneously |
Radiological Changes |
Chest X-ray is usually normal or only shows mild increased texture (if no concurrent pneumonia) |
Chest X-ray is normal (no substantive pulmonary lesions) |
Treatment Response |
Gradual improvement with symptomatic treatment; antibiotics are not necessarily needed unless there is evidence of bacterial infection (such as purulent sputum); good response to bronchodilators if bronchial spasm is present |
Generally self-limiting, no need for antibiotics (antibiotics are not beneficial for post-viral cough); mainly symptomatic cough suppression, short-term use of cough suppressants, first-generation antihistamines + decongestants, etc., to relieve symptoms; usually no need for hormone treatment |
3.2Differential Analysis
In this case, the patient’s cough has only lasted for 1 week and is still in the acute phase, which does not meet the time standard of post-infectious cough that needs to last more than 3 weeks. The patient is currently still in the recovery process of the infection (the symptoms are improving after antibiotic treatment), and it cannot be classified as residual cough after infection. On the contrary, it is more consistent with the presentation of acute bronchitis: the initial onset was suspected to be an upper respiratory tract infection, followed by worsening cough and purulent sputum, indicating acute bronchial inflammation with bacterial infection. After anti-infective treatment, the sputum volume decreased and the cough improved, indicating that the inflammation is in the recovery phase. Therefore, the cough in this case is more likely to be a symptom of acute bronchitis rather than pure post-infectious cough. Only if the cough persists for more than 3 weeks after the acute phase infection is controlled, should the diagnosis of “post-infectious cough” be considered. If the patient’s cough persists into the subacute stage of 3–8 weeks in the future, it will be necessary to re-evaluate whether it has turned into PIC or if there are other causes for the persistent cough.
Additionally, it is necessary to differentiate from pneumonia. Although the patient has purulent sputum and night sweats, there is no fever, and the general condition is still acceptable. The symptoms have significantly improved after antibiotic treatment, which does not support the presentation of severe pneumonia. If the heart rate of a patient with acute bronchitis is 
100 beats per minute, the respiratory rate is 
24 breaths per minute, the body temperature is 
38℃, and there are no signs of consolidation on lung auscultation, the possibility of pneumonia is relatively low. It is inferred that the patient’s vital signs are stable in this case (the problem does not mention abnormal body temperature or respiratory rate), and there are no signs of lung consolidation, so the possibility of community-acquired pneumonia is not significant. However, when a middle-aged patient presents with acute cough and purulent sputum during the initial visit, doctors usually need to be vigilant about the possibility of pneumonia and may arrange for chest imaging to rule out pneumonia at their discretion. If a chest X-ray has been performed previously and no abnormalities were found, it further supports the diagnosis of bronchitis; if no imaging examination has been performed, but the patient’s symptoms have improved now, it also suggests that it was likely only bronchitis rather than pneumonia at that time.
Finally, it is necessary to consider less common but important differentials such as pulmonary tuberculosis. Tuberculous cough often persists for 
2 weeks and is accompanied by symptoms such as night sweats and low-grade fever. Guidelines in our country suggest that cough and sputum lasting for 2 weeks or more should be considered for screening of pulmonary tuberculosis. In this case, the patient’s cough has only lasted for 1 week, which is not sufficient to suspect tuberculosis. Moreover, the symptoms improved after conventional antibiotic treatment, which does not fit the typical course of pulmonary tuberculosis (tuberculosis does not respond to cephalosporin antibiotics). Therefore, pulmonary tuberculosis does not need to be considered as the primary diagnosis at present. However, if the cough persists for more than 2–3 weeks without relief, further medical examination will be needed to clarify the cause, including necessary tuberculosis-related tests.
4Need for Further Examination or Medical Visit
Based on the patient’s current condition, there are no urgent signs that necessitate further medical examination. The patient’s symptoms have improved with the current treatment, the body temperature is normal, and there are no warning signs such as hemoptysis or persistent high fever. Therefore, it is possible to continue observation and treatment on an outpatient basis. As for whether imaging or laboratory tests are needed, the following points can be considered:
4.1Pneumonia Assessment
As previously mentioned, the patient has no obvious signs of pneumonia such as fever or worsening dyspnea, and the purulent sputum symptoms have improved. According to guidelines, if clinical judgment suggests a low possibility of pneumonia, routine chest X-ray examination is not necessary. Acute bronchitis usually shows no significant fixed rales on lung auscultation, and chest radiographs are often normal or only show mild inflammatory changes. Therefore, in the case of symptom improvement, chest X-ray examination can be temporarily withheld. However, if the patient had a chest X-ray at the initial visit to rule out pneumonia, it is now safe to treat it as bronchitis; if no imaging was performed initially, but the condition recurs or worsens later, supplementary examination will be needed.
4.2Blood Routine and Other Tests
For patients with mild symptoms of acute bronchitis that are improving, routine blood tests or sputum cultures are generally not necessary. If there was initially a high fever or suspicion of bacterial infection, a blood routine test may help assess the degree of infection (e.g., elevated white blood cells). In this case, the patient’s condition is relatively mild, and whether to recheck the blood routine can be decided based on clinical recovery. Currently, with symptom improvement, blood tests are not mandatory, but if the cough worsens or fever recurs later, it may be necessary to recheck the blood routine, C-reactive protein, and other indicators to assess whether there is any new infection progression.
4.3Pulmonary Function and Allergy Assessment
Since the patient has no history of asthma or allergies, and the current symptoms are improving, there is no need for pulmonary function tests or bronchial provocation tests at present. If the cough persists for more than 8 weeks and turns into chronic cough in the future, or if there are recurrent wheezing and dyspnea, it will be necessary to consider pulmonary function tests, airway provocation tests, and other examinations to determine whether there is variable asthma or other chronic respiratory diseases.
4.4Indications for Re-visit
The patient should closely monitor any changes in symptoms. If any of the following situations occur, it is recommended to seek medical attention promptly for further evaluation or examination:
·Persistent or worsening cough: If the cough persists for more than 3 weeks without improvement (entering the subacute/chronic stage), a medical visit is necessary to further assess and rule out the possibility of post-infectious cough evolving into other diseases (such as chronic bronchitis, cough-variant asthma, etc.).
·New symptoms: If there is a recurrence of fever, chest pain, hemoptysis, or persistent and worsening night sweats, it is necessary to seek medical attention promptly to complete chest X-ray or CT examinations to rule out rare causes such as pneumonia, tuberculosis, or tumors.
·Deterioration of general condition: If there is significant worsening of dyspnea or if breathing difficulties affect daily activities, it is necessary to seek medical attention as soon as possible to check oxygen saturation and pulmonary status.
5Subsequent Treatment and Monitoring Recommendations
Based on the current assessment, the following subsequent management and monitoring recommendations are proposed for the patient’s acute bronchitis:
5.1Completion of Antibiotic Course
The patient has taken Cefaclor for 3 days and the symptoms have improved. It is recommended to follow the doctor’s advice and complete the full course of treatment (usually 5–7 days or adjusted by the doctor according to the situation) to completely eliminate the bacterial infection focus and prevent symptom recurrence. It is important to take the medication on time and in full doses, and even if the symptoms improve, the course should be completed to prevent bacterial resistance and persistent infection.
5.2Symptomatic Supportive Treatment
The treatment of acute bronchitis is mainly symptomatic. For the remaining symptoms of the patient, the following measures can be taken:
·Cough suppression: For nighttime irritative dry cough that affects sleep, cough suppressants can be taken before bedtime as needed. Central-acting cough suppressants (such as dextromethorphan) can be chosen, or if necessary, codeine-based cough suppressant syrups can be used short-term and in small doses under the guidance of a physician to reduce nighttime coughing. It should be noted that these should only be used when the cough is severe enough to affect rest, and strong cough suppressants should not be misused during the day when there is a lot of sputum, as this may affect sputum expulsion.
·Expectoration: Although the patient’s sputum has significantly decreased, if there is still viscous sputum that is difficult to cough up, expectorants or mucolytics (such as ambroxol, acetylcysteine, etc.) can be used to help dilute the sputum and promote expectoration. Adequate fluid intake also helps to dilute secretions and facilitate sputum expulsion.
·Nebulization inhalation: If there is significant throat irritation, nebulization therapy can be considered to relieve airway irritation. Normal saline nebulization can be used to moisten the airway and reduce throat discomfort. If necessary, under the guidance of a doctor, a small amount of bronchodilator or corticosteroid can be added to the nebulization (however, corticosteroids are generally used in cases of airway hyperreactivity, and are not recommended for routine use in post-infectious irritation).
·Other soothing measures: Maintain an appropriate humidity level in the indoor air, avoid cold air irritation (cold air can exacerbate coughing), and avoid smoking and second-hand smoke environments (smoke can worsen airway inflammation). At night, the pillow can be elevated slightly to reduce the irritation of pharyngeal secretions on the throat when lying on the back. The hoarseness has recovered, but the vocal cords may not have fully returned to normal, so it is important to avoid prolonged loud talking, and to gargle with warm water or suck on throat lozenges to relieve throat discomfort.
5.3Monitoring Airway Reactivity
Since the patient reported brief episodes of chest tightness and shortness of breath, which suggests the possibility of transient bronchial spasm. If patients with acute bronchitis show signs of bronchial spasm (cough with wheezing or chest tightness), inhaled β2-agonists (such as salbutamol inhaler) can be used to relieve bronchial spasm. It is recommended that the patient pay attention to any wheezing or persistent chest tightness. If chest tightness at night is still difficult to relieve, it is advisable to consult a doctor about whether to use an inhaler for treatment. Generally speaking, in acute bronchitis with “cough and wheezing” manifestations, the use of bronchodilators can improve symptoms. If there is no significant wheezing, such drugs do not need to be used routinely.
5.4Continued Monitoring of Recovery Process
The patient is advised to rest peacefully, ensure adequate sleep and nutrition. Acute bronchitis usually shows significant improvement within about 2 weeks, and most patients recover within 3 weeks. The patient is reminded that even if the symptoms are reduced, they should avoid overexertion, especially paying attention to keeping warm at night to prevent relapse of cough due to catching a cold. The patient can measure their body temperature at least once a day to monitor for any recurrence of fever. Attention should be paid to the nature of the sputum. If there is an increase in purulent sputum or blood streaks again, medical attention should be sought promptly.
5.5Vigilance for Disease Progression
During the recovery period, the patient needs to be vigilant for the following situations and take timely measures:
·Persistent cough: If the cough persists for more than 3 weeks without complete resolution, it suggests the possibility of post-infectious cough (PIC). PIC often occurs after viral infections. Although most cases resolve spontaneously, persistent PIC may require symptomatic treatment. If PIC develops, short-term oral administration of first-generation antihistamines combined with decongestants and cough suppressants can be used to alleviate symptoms. For example, compound cough suppressants containing chlorpheniramine (first-generation antihistamine) and pseudoephedrine (decongestant) are recommended in guidelines for symptomatic treatment of cough remaining after colds or infections. It should be noted that the use of corticosteroid inhalers or leukotriene receptor antagonists to treat pure PIC is not recommended, as studies have shown that these drugs are not significantly effective for post-infectious cough. At the same time, it is important to rule out other causes of persistent cough, such as cough-variant asthma (often with significant nocturnal cough and possible wheezing) or eosinophilic bronchitis. If conventional symptomatic treatment for PIC is ineffective, further medical examination will be needed (such as bronchial provocation tests, pulmonary function tests, and chest CT) to clarify the diagnosis.
·Relapse or worsening of condition: If symptoms worsen during the recovery process, such as a recurrence of high fever, a significant increase in sputum volume and purulence, it suggests that bacterial infection may not be controlled or a new infection has occurred. In this case, a prompt re-visit is necessary. It may be necessary to adjust antibiotics or perform sputum culture to identify the pathogen. If chest pain or significant worsening of dyspnea occurs, it is necessary to be vigilant for possible pulmonary complications (such as the rare empyema, pulmonary embolism, etc.) or other diseases, and immediate medical attention is required.
·Chronic cough: If the cough persists for more than 8 weeks (evolving into chronic cough), a comprehensive examination will be needed according to the diagnostic approach for chronic cough. The common causes of chronic cough are different from those in the acute phase, including chronic rhinitis with postnasal drip, gastroesophageal reflux, asthma, chronic obstructive pulmonary disease, etc., and corresponding specialist evaluation is required. At that time, a respiratory physician should conduct a systematic examination and targeted treatment.
5.6Lifestyle Adjustment and Prevention
The patient is advised to avoid smoking and drinking during the recovery period, maintain a light diet, and engage in appropriate exercise to boost immunity. During the high-incidence season of respiratory infections, protective measures should be taken (such as wearing masks and frequent hand washing) to avoid catching a cold again. Indoor air circulation and appropriate humidity should be maintained, and a humidifier can be used if conditions permit to reduce nocturnal cough triggers. Since the patient has no clear history of allergies, but if sensitive to dust or cold air, temporary avoidance of such irritants is recommended. After complete recovery, normal activities can be gradually resumed, but it should be done step by step to avoid excessive fatigue.
The clinical manifestations and treatment response of this patient are consistent with the diagnostic characteristics of acute bronchitis. The current symptoms are trending towards improvement, and the prognosis is good. It is recommended that the patient continue treatment and adjustment according to the above plan. In most cases, the cough will gradually disappear within 2–3 weeks. During this period, the patient should closely monitor any changes in the condition and seek medical attention promptly if any abnormalities occur. According to authoritative guidelines, there is no need for excessive worry about serious diseases in this case, but it is also important to avoid neglect. Through standardized treatment and patient care, the patient is expected to fully recover. If new situations arise in the future, further examinations and treatments can be carried out according to the guidelines to ensure safety. Wishing the patient a speedy recovery!
6Medication Treatment Plan for Cough in the Recovery Period of Acute Bronchitis
6.1Antibiotic Treatment
Whether to continue antibiotics: Most cases of acute bronchitis are caused by viruses and do not require routine antibiotics. The patient’s sputum volume has decreased after 3 days of Cefaclor treatment. If there is no persistent purulent sputum or fever, antibiotics can be temporarily discontinued to avoid unnecessary adverse reactions. However, if there is still suspicion of residual bacterial or mycoplasma infection (such as sputum turning purulent again or worsening symptoms), it may be considered to complete a 5–7 day course of antibiotics. Oral Amoxicillin-Clavulanate (brand name such as “Augmentin”, 0.5g per dose, 3 times a day) or continued use of Cefaclor (0.5g per dose, 3 times a day) is recommended to cover common bacteria (prescription drugs). If pneumonia mycoplasma or pertussis infection is suspected, macrolide antibiotics such as Azithromycin can be used (e.g., “Zithromax” Azithromycin tablets 0.25g, 2 tablets once a day for 3 days). The role of antibiotics is to eliminate residual bacterial infections and prevent persistent cough; they should be used with a doctor’s prescription.
6.2Cough Suppressants (Antitussives)
·Dextromethorphan oral solution (brand name such as Hufening Cough Syrup): Adults 30 mg (about 10 ml) per dose, 3 times a day, with an additional dose before bedtime if necessary. Dextromethorphan is a non-addictive central-acting cough suppressant that reduces dry cough and paroxysmal cough by inhibiting the medullary cough center. It is suitable for nocturnal paroxysmal cough that affects sleep and can significantly relieve symptoms of throat itching and cough. This drug is an over-the-counter drug in China, and patients can purchase it on their own, but it should be taken according to the recommended dosage to avoid overdose. According to the Chinese Cough Guidelines, the effect of using a single central-acting cough suppressant is limited, and it can be combined with antiallergic drugs to enhance the antitussive effect.
·Phosphate codeine sustained-release tablets (brand name such as Codeine Tablets): Adults 15–30 mg per dose, up to 90 mg per day, with one tablet before bedtime if necessary. Codeine is an opioid central-acting cough suppressant that inhibits the cough center and has a stronger antitussive effect than dextromethorphan. It is suitable for patients with severe cough that affects rest, but because it may cause drowsiness, constipation, and mild addiction, it is generally used as an alternative short-term measure. Codeine is a prescription drug, and its purchase and use should follow the doctor’s advice. When using it, it should not be used with alcohol or other central nervous system depressants.
Dextromethorphan and other non-addictive cough suppressants are the first choice to relieve symptoms. If nighttime cough is severe, codeine and other potent cough suppressants can be used as an adjunct under the guidance of a doctor. The two should not be used simultaneously to avoid excessive cough suppression that may affect sputum expulsion.
6.3Expectorants
·Ambroxol hydrochloride (brand name such as沐舒坦, generic name Ambroxol): 30 mg per dose, 3 times a day, after meals. Ambroxol is a mucolytic agent that promotes the dilution of sputum and ciliary movement, helping to expel viscous sputum and reducing airway irritation. For the remaining sputum and irritative cough in this case, ambroxol can be used as the first-line expectorant (prescription drug). If an alternative is needed, Bromhexine (brand name Bisolvon, 8 mg per dose, 3 times a day) or Acetylcysteine effervescent tablets (600 mg per dose, once a day) can be selected. The goal is to dilute sputum and reduce the difficulty of expectoration. These drugs are safe and can be used in combination with cough suppressants to relieve cough while maintaining sputum drainage.
Ambroxol is the first choice of expectorant in this case, which can effectively improve the viscosity of residual sputum. For patients with a lot of viscous sputum, Acetylcysteine can also be considered as an adjunct. Expectorants are prescription drugs or Class A over-the-counter drugs, and it is safer to take them as instructed.
6.4Bronchodilators
·Salbutamol inhaler (brand name such as Ventolin, generic name Salbutamol): Each puff contains 100 μg, adults can inhale 2 puffs per dose, and it can be used 3–4 times a day as needed to relieve symptoms. Salbutamol is a short-acting β₂-agonist that relaxes bronchial smooth muscle to dilate the airways and rapidly relieve bronchial spasm and airway hyperreactivity. In this case, the patient occasionally experiences chest tightness and shortness of breath, and is suspected of having mild airway hyperreactivity. Inhaling salbutamol can relieve spasmodic cough and a sense of urgency in the airways, and improve nocturnal respiratory comfort. The method of use is to inhale deeply while pressing the inhaler to ensure that the drug fully enters the lower respiratory tract. Salbutamol is a prescription drug and needs to be purchased with a doctor’s prescription. If side effects such as palpitations or hand tremors occur during use, the doctor can be contacted to adjust the dosage and frequency.
·Theophylline sustained-release tablets (alternative): 0.1 g per dose, 2–3 times a day orally. Theophylline is a xanthine bronchodilator that relaxes bronchial smooth muscle and reduces airway spasm. If an inhaler is not available, or if the patient has significant nocturnal cough with asthma-like symptoms, it can be considered to take sustained-release theophylline before bedtime to maintain the bronchodilator effect. However, the therapeutic window of theophylline is narrow, and it can easily cause side effects such as palpitations and insomnia, so it should be used under the guidance of a doctor (prescription drug).
For this case, the first choice is to use inhaled short-acting β₂-agonist salbutamol as needed to quickly and safely relieve airway spasm and nocturnal cough and wheezing. Oral xanthines are only an alternative when inhalers cannot be used.
6.5Antiallergic and Other Adjuvant Drugs
·Chlorpheniramine maleate (brand name Piriton): 4 mg per dose, taken before bedtime at night, and if necessary, one dose can be added during the day. Chlorpheniramine is a first-generation antihistamine H₁ receptor antagonist, which has sedative and antiallergic effects, and can relieve symptoms of throat itching and airway irritation. When taken at night, it can work synergistically with cough suppressants to relieve paroxysmal cough and improve sleep quality. Common side effects include drowsiness and dry mouth, so it is recommended to use mainly at night. Piriton is an over-the-counter drug in China, and patients can purchase it on their own. It should be noted that it should not be taken before driving or working at heights during the day.
·Ketotifen fumarate (brand name such as Ketotifen Tablets): 1 mg per dose, 2 times a day, taken before bedtime. Ketotifen has both antihistamine and mast cell stabilizing effects, and is used for allergic cough or mild asthmatic bronchitis. For patients suspected of having airway hyperreactivity, continuous use of ketotifen can reduce airway allergic reactivity and prevent cough attacks. Its sedative side effects are similar to those of Piriton. Ketotifen is a prescription drug and can be used as an adjuvant drug for patients with persistent cough and a tendency towards asthma.
The above antiallergic drugs can be selected according to symptoms. Chlorpheniramine is the first choice for short-term adjuvant cough suppression. If the patient has significant airway hyperreactivity or an allergic constitution, it can be changed to ketotifen and other drugs under the guidance of a doctor, and taken regularly for more than 2 weeks. It should be noted that the latest guidelines do not recommend the routine use of leukotriene receptor antagonists (such as Montelukast) or inhaled corticosteroids for the treatment of general post-infectious cough, as the evidence of efficacy is insufficient. Only when cough-variant asthma or other clear airway inflammation is suspected, inhaled corticosteroids such as Budesonide should be considered for treatment (prescription drugs).
6.6Traditional Chinese Medicine and Other Combined Treatments
·Su Huang Antitussive Capsules: 1.35 g per dose (usually 3 capsules), 3 times a day, for a course of 1–2 weeks. This product is a traditional Chinese medicine compound containing ingredients such as Ephedra, Perilla leaf, Earthworm, and Loquat leaf. In traditional Chinese medicine, it is used for cough caused by “wind evil invading the lung”. Modern pharmacological studies have shown that it has a comprehensive effect of relieving asthma, suppressing cough, and expectorating phlegm, which can reduce the frequency of cough and relieve throat itching. The Chinese Cough Treatment Guidelines list Su Huang Antitussive Capsules as one of the effective treatments for post-infectious cough. This medicine is an over-the-counter traditional Chinese medicine and can be purchased at pharmacies, especially suitable for patients with airway hyperreactivity and significant nocturnal cough as an adjuvant treatment.
·Chuanbei Loquat Syrup (such as Chuanbei Loquat Syrup): 15–30 ml per dose, 3 times a day. Made from traditional Chinese medicines such as Fritillaria and Loquat leaf, this cough syrup has the effects of moistening the lungs, relieving cough, and expectorating phlegm, which can relieve dry throat and itching and reduce cough. It is suitable for patients with dry cough and nocturnal throat itching as an adjuvant. Chuanbei Loquat Syrup is an over-the-counter drug and can be used in combination with the above Western medicines. However, it should be noted that the syrup contains a high amount of sugar, so patients with diabetes should use it with caution.
6.7Other Nursing Measures
The patient is advised to rest and keep warm, drink plenty of warm water to help dilute and expel sputum. A humidifier can be used at night to maintain indoor humidity and reduce the irritation of dry air on the airways. Avoid contact with smoke and dust and other irritants to prevent worsening of cough. The above lifestyle measures can improve the efficacy of drugs and promote recovery.
7Summary of Medication Plan
For this 48-year-old patient without underlying diseases, who is currently in the recovery period of acute bronchitis, the first-choice plan is mainly symptomatic treatment, taking into account the control of airway reactivity. It is recommended to use Dextromethorphan syrup combined with Ambroxol to improve cough and sputum, with Salbutamol inhaler added as needed to relieve airway spasm, and Chlorpheniramine used at night to reduce throat itching and irritation. This combination is effective and safe, and can effectively relieve moderate to severe symptoms. Antibiotics should be used according to the situation and are not necessary for everyone. In addition, according to the patient’s willingness, traditional Chinese medicines such as Su Huang Antitussive Capsules can be used as adjuvants to enhance the efficacy. In summary, the first-choice plan focuses on cough suppression, expectoration, and airway dilation, and adjuvant plans can be considered to add antiallergic drugs and traditional Chinese medicines as appropriate. This approach controls symptoms while avoiding overtreatment, in line with the requirements of the clinical guidelines for the treatment of acute tracheobronchitis in the recovery period in Mainland China.
8References
·Chinese Medical Association Respiratory Society: “Guidelines for the Diagnosis and Treatment of Cough (2021)”, published in Chinese Journal of Tuberculosis and Respiratory Diseases, Vol. 45, No. 1, 2022, pp. 13–46.
·World Health Organization and Chinese Tuberculosis Prevention and Control Guidelines: Cough and sputum lasting for more than 2 weeks should raise suspicion of tuberculosis.
·Merck Manual (Chinese Edition) on the chapter of acute bronchitis: Description of the definition, etiology, and treatment of acute tracheobronchitis.
·Chinese “Guidelines for the Diagnosis and Treatment of Cough”, “Medication Guidance for Acute Tracheobronchitis”, and related literature.
9Appendix
9.1Summary of Symptom Characteristics
·Cough
oParoxysmal, worse at night/nap time, affecting sleep
oAccompanied by green purulent sputum (possible bacterial infection), sputum volume decreased after Cefaclor treatment
oIndication: Post-infectious cough or postnasal drip syndrome are highly likely
·Night sweats
oNo fever, prominent at night, need to be vigilant:
§Tuberculosis infection (need to investigate history of tuberculosis contact, chest X-ray/PPD test)
§Non-infectious causes (such as anxiety, endocrine disorders)
oCurrent indication strength: need to further rule out tuberculosis
·Throat itching
oProminent at night, accompanied by cough, may be related to airway hyperreactivity (such as allergic cough, cough-variant asthma) or upper respiratory tract inflammation
·Transient aphonia
oTransient, has recovered, indicates laryngeal or vocal cord inflammation (such as early acute laryngitis)
9.2Possible Diagnostic Directions
·Post-infectious cough
oIncreased airway sensitivity after viral or bacterial infection, usually lasting 1–3 weeks, worse at night
oSupporting points: green purulent sputum (sign of bacterial infection), effective treatment with Cefaclor
·Postnasal drip syndrome
oSecretions from rhinitis/sinusitis irritate the throat, causing nocturnal cough and itching. Need to check for sinus tenderness and nasal discharge
·Cough-variant asthma (CVA)
oMainly nocturnal cough, airway hyperreactivity, but usually with little sputum. Need to confirm with pulmonary function tests and bronchial provocation tests
·Tuberculosis infection
oNight sweats need to be vigilant, but need to be further investigated in combination with low-grade fever, weight loss, abnormal chest X-ray, etc.
9.3Recommended Tests
·Initial tests: Complete blood count, CRP, chest X-ray (to rule out pneumonia/tuberculosis)
·Specialist tests (if persistent):
oOtolaryngology (assessment of sinusitis, allergic rhinitis)
oRespiratory medicine (pulmonary function tests, exhaled nitric oxide measurement)
·Tuberculosis screening (such as PPD test, T-SPOT) if night sweats persist or other tuberculosis symptoms appear
9.4Treatment Suggestions
·Symptomatic treatment:
oCough suppression: Dextromethorphan (for dry cough) or honey (1 tablespoon for adults before bedtime)
oExpectorant: Ambroxol (if sputum is viscous and difficult to cough up)
oThroat itching: Suck on menthol throat lozenges or antihistamines (such as Loratadine, excluding allergic factors)
·Etiological treatment:
oIf bacterial sinusitis is suspected: prolong the course of antibiotics (such as Amoxicillin-Clavulanate)
oIf CVA is suspected: trial inhalation of corticosteroids (under doctor’s guidance)
·Monitoring and follow-up:
oIf symptoms do not improve after 3 weeks, or if fever, weight loss, etc. appear, a timely follow-up visit is necessary
9.5Precautions
·Avoid smoking and cold air irritation
·Elevating the pillow at night may reduce the irritation of postnasal drip
·Record changes in symptoms (such as frequency of night sweats, sputum characteristics) for reference during follow-up visits
9.6In-depth Assessment: Symptom Mechanisms, Differential Diagnosis, and Further Analysis
9.6.1Pathological Mechanism Analysis of Nocturnal Symptom Aggravation
·Nocturnal worsening of cough
oPhysiological factors: Increased excitability of the vagus nerve at night, increased airway sensitivity; in the supine position, nasal sinus secretions are more likely to reflux and irritate the throat (postnasal drip)
oEnvironmental factors: Dust mites in the bedroom, cold air, and dry environment induce airway reactivity
oDisease-related:
§Gastroesophageal reflux disease (GERD): Gastric acid reflux during supine position irritates the throat, need to investigate symptoms of acid reflux and heartburn
§Asthma/CVA: Increased airway constriction at night, may be accompanied by wheezing (but CVA is usually dry cough)
·Prominent night sweats at night
oInfectious: Tuberculosis (low-grade fever, weight loss), subacute bacterial endocarditis
oNon-infectious:
§Endocrine: Hyperthyroidism (with palpitations, hand tremors), menopausal syndrome
§Tumor: Lymphoma (with lymph node enlargement, weight loss)
§Drugs/Psychological: Side effects of antidepressants, anxiety disorder (need to be combined with psychological assessment)
9.6.2Refined Differential Diagnosis of Key Symptoms
Refined Differential Diagnosis of Key Symptoms
Symptom |
Primary Consideration |
Serious Diseases to Exclude |
Paroxysmal nocturnal cough + green sputum |
Bacterial sinusitis, post-infectious cough |
Bronchiectasis, pneumonia |
Night sweats without fever |
Tuberculosis, anxiety/endocrine disorders |
Lymphoma, chronic infections (Brucellosis) |
Throat itching + aphonia |
Laryngitis, GERD, allergy |
Laryngeal tumor (e.g., vocal cord polyps) |
9.6.3Extended Differential Diagnosis Checklist
·Infectious diseases
oChronic bacterial bronchitis
oAtypical pathogens (Mycoplasma/Chlamydia infections)
·Non-infectious diseases
oUpper airway cough syndrome (UACS)
oGastroesophageal reflux cough (GERC)
oEosinophilic bronchitis
9.6.4Further Examination Recommendations (in Order of Priority)
·Infection and Inflammation Assessment
oSputum examination: Gram staining, culture + sensitivity
oSerology: Procalcitonin, IgE, tuberculosis antibodies/T-SPOT
·Airway and Structural Assessment
oPulmonary function tests + bronchial provocation tests
oSinus CT
oLaryngoscopy/gastroscopy
·Tumor/Systemic Disease Screening
oChest CT
oLymph node ultrasound
9.6.5Refined Treatment Strategies
·For bacterial infections
oUpgrade antibiotics (e.g., Amoxicillin-Clavulanate, quinolones)
oDetermine the course of treatment (10–14 days for sinusitis, 7–10 days for bronchial infections)
·Control airway hyperreactivity
oTrial treatment for CVA (Budesonide/Formoterol inhaler)
oAntiallergic treatment (Omalizumab)
·Management of gastroesophageal reflux
oLifestyle adjustments (avoid eating 3 hours before bedtime, elevate the head of the bed)
oMedication treatment (PPI in combination with prokinetic drugs)
9.6.6Warning Signs and Urgent Referral Indications
·Immediate medical attention: Hemoptysis, dyspnea, persistent fever 
38.5℃, rapid weight loss (
5%)
·Follow-up within 72 hours: Worsening night sweats, cough with chest pain, ineffective antibiotic treatment
9.6.7Patient Education Key Points
·Keep a symptom diary (frequency of cough, sputum color, number of night sweats, association with diet/position)
·Avoid triggers (cold drinks, smoke, perfume, etc.; use humidifiers/dust mites in the bedroom)
·Medication adherence (complete the course of antibiotics, rinse mouth after corticosteroid inhalation to prevent fungal infections)
9.7Summary
Currently, it is necessary to prioritize the investigation of bacterial sinusitis and tuberculosis infection, and to perform pulmonary function tests to clarify the possibility of CVA. If empirical treatment for 2 weeks shows no improvement, tumor/immune system screening should be initiated. The etiology of night sweats needs to be combined with systemic manifestations to avoid missing malignant diseases. It is recommended to develop an individualized plan under the joint follow-up of respiratory and otolaryngology departments.
