Akuter und chronischer Husten – Differenzialdiagnose und Behandlung

Husten ist ein häufiger Konsultationsgrund in der hausärztlichen Praxis. Meist ist das Symptom harmlos und selbstlimitierend wie z.B. bei einem banalen Erkältungshusten – jedoch können auch schwerwiegende Erkrankungen wie Malignome die Ursache sein. Die Abklärung ist daher nicht immer einfach. Dieser Beitrag stellt ein gezieltes und angemessenes Vorgehen dar und diskutiert, welche Behandlungen empfohlen und effektiv sind.

Schlüsselwörter

akuter Husten - chronischer Husten - Hausarztpraxis - Differenzialdiagnose

Publication History

Article published online:
09 November 2021

• Literatur

• 1 Laux G, Rosemann T, Körner T. et al. Detailed data collection regarding the utilization of medical services, morbidity, course of illness and outcomes by episode-based documentation in general practices within the CONTENT project. Gesundheitswesen 2007; 69: 284-291 DOI: 10.1055/s-2007-976517. (PMID: 17582545)
• 2 Chung KF, Pavord ID. Prevalence, pathogenesis, and causes of chronic cough. Lancet 2008; 371: 1364-1374 DOI: 10.1016/S0140-6736(08)60595-4. (PMID: 18424325)
• 3 Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (BAuA). Volkswirtschaftliche Kosten durch Arbeitsunfähigkeit 2018. https://www.baua.de/DE/Themen/Arbeitswelt-und-Arbeitsschutz-im-Wandel/Arbeitsweltberichterstattung/Kosten-der-AU/Kosten-der-Arbeitsunfaehigkeit_node.html [2021–05–20]
• 4 Krüger K, Gehrke-Beck S, Holzinger F. et al. S3 Leitlinie akuter und chronischer Husten der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). 2021
• 5 Altiner A, Wilm S, Däubener W. et al. Sputum colour for diagnosis of a bacterial infection in patients with acute cough. Scand J Prim Health Care 2009; 27: 70-73 DOI: 10.1080/02813430902759663. (PMID: 19242860)
• 6 van der Meer V, Neven AK, van den Broek PJ. et al. Diagnostic value of C reactive protein in infections of the lower respiratory tract: systematic review. BMJ (Clinical research ed) 2005; 331: 26 DOI: 10.1136/bmj.38483.478183.EB. (PMID: 15979984)
• 7 van Vugt SF, Broekhuizen BDL, Lammens C. et al. Use of serum C reactive protein and procalcitonin concentrations in addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough: diagnostic study. BMJ 2013; 346: f2450 DOI: 10.1136/bmj.f2450. (PMID: 23633005)
• 8 Holm A, Pedersen SS, Nexoe J. et al. Procalcitonin versus C-reactive protein for predicting pneumonia in adults with lower respiratory tract infection in primary care. Br J Gen Pract 2007; 57: 555-560 (PMID: 17727748)
• 9 Huang Y, Chen R, Wu T. et al. Association between point-of-care CRP testing and antibiotic prescribing in respiratory tract infections: a systematic review and meta-analysis of primary care studies. Br J Gen Pract 2013; 63: e787-e794 DOI: 10.3399/bjgp13X674477. (PMID: 24267862)
• 10 Schuetz P, Wirz Y, Sager R. et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochr Data Syst Rev 2017; 10: Cd007498 DOI: 10.1002/14651858.CD007498.pub3. (PMID: 29025194)
• 11 Wood F, Brookes-Howell L, Hood K. et al. A multi-country qualitative study of clinicians' and patients' views on point of care tests for lower respiratory tract infection. Fam Pract 2011; 28: 661-669 DOI: 10.1093/fampra/cmr031. (PMID: 21653924)
• 12 Smith SM, Fahey T, Smucny J. et al. Antibiotics for acute bronchitis. 2017; DOI: 10.1002/14651858.CD000245.pub4.. (PMID: 28626858)
• 13 Sierocinski E, Holzinger F. Ivy leaf (Hedera helix) for acute upper respiratory tract infections: an updated systematic review. Eur J Clin Pharmacol 2021; 77: 1113-1122 DOI: 10.1007/s00228-021-03090-4. (PMID: 33523253)
• 14 Matthys H, de Mey C, Carls C. et al. Efficacy and tolerability of myrtol standardized in acute bronchitis. A multi-centre, randomised, double-blind, placebo-controlled parallel group clinical trial vs. cefuroxime and ambroxol. Arzneimittelforschung 2000; 50: 700-711 DOI: 10.1055/s-0031-1300276. (PMID: 10994153)
• 15 Kemmerich B, Eberhardt R, Stammer H. Efficacy and tolerability of a fluid extract combination of thyme herb and ivy leaves and matched placebo in adults suffering from acute bronchitis with productive cough. A prospective, double-blind, placebo-controlled clinical trial. Arzneimittelforschung 2006; 56: 652-660 DOI: 10.1055/s-0031-1296767. (PMID: 17063641)
• 16 Spurling GK, Del Mar CB, Dooley L. et al. Delayed antibiotic prescriptions for respiratory infections. Cochr Data Syst Rev 2017; 9: Cd004417 DOI: 10.1002/14651858.CD004417.pub5. (PMID: 28881007)
• 17 Coxeter P, Del Mar CB, McGregor L. et al. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochr Data Syst Rev 2015; 2015: Cd010907 DOI: 10.1002/14651858.CD010907.pub2. (PMID: 26560888)
• 18 McNally M, Curtain J, O'Brien KK. et al. Validity of British Thoracic Society guidance (the CRB-65 rule) for predicting the severity of pneumonia in general practice: systematic review and meta-analysis. Br J Gen Pract 2010; 60: e423-433 DOI: 10.3399/bjgp10X532422. (PMID: 20883616)
• 19 Ewig S, Kolditz M, Pletz M. et al. Leitlinie Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie – Update 2021. 2021
• 20 Irwin RS, French CL, Chang AB. et al. Classification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report. Chest 2018; 153: 196-209 DOI: 10.1016/j.chest.2017.10.016. (PMID: 29080708)
• 21 Smith JA, Kitt MM, Morice AH. et al. Gefapixant, a P2X3 receptor antagonist, for the treatment of refractory or unexplained chronic cough: a randomised, double-blind, controlled, parallel-group, phase 2b trial. Lancet Resp Med 2020; 8: 775-785 DOI: 10.1016/S2213-2600(19)30471-0. (PMID: 32109425)