[Specific respiratory tract infections in acute cough-when is targeted diagnosis and treatment required?]

In most cases, acute cough is caused by a self-limiting respiratory infection. However, symptoms, pre-existing conditions, or environmental factors may indicate a cause requiring treatment; red flags point to dangerous courses, the NEWS2 score can assess the risk of septic deterioration, and the CRB-65 score supports decision-making regarding hospital admission in pneumonia. Pneumonia cannot be reliably diagnosed clinically but is unlikely in the absence of clinical indicators. Laboratory tests can support the decision for antibiotic treatment, while the diagnosis is confirmed by chest X‑ray. An infection-related exacerbation of pre-existing chronic obstructive pulmonary disease (COPD) should be specifically treated. In influenza, coronavirus disease 2019 (COVID-19), and respiratory syncytial virus (RSV), complications and severe courses may occur more frequently in risk populations. However, routine diagnostic confirmation of these pathogens is not useful in the absence of therapeutic consequences. With appropriate exposure and waning vaccine protection, pertussis can also be a cause of acute cough in adults.