cough-respiratory

name: cough-respiratory description: Use when a caller reports cough, wheezing, breathing difficulty, stridor, chest tightness, or any respiratory complaint in themselves or a dependent of any age — with a lower threshold to escalate for children. Produces a three-way next-action decision — Call (emergency or hotline), Go (open pharmacy), or Wait (home self-care) — with the Yorukusu safety boundary on every output. Inputs include age, cough character (dry, wet, barky, paroxysmal), respiratory work-of-breathing signs, duration, concurrent fever, known respiratory conditions, and the caller's Personal Health Context. Never outputs a diagnosis and never recommends prescription medication.

Cough and Respiratory Triage

Yorukusu does not diagnose. Pharmacist-informed, not pharmacist-replacing.

When to invoke this skill

Invoke when the caller's message indicates cough, wheezing, breathing difficulty, or any other respiratory-tract complaint. Child respiratory presentations are prioritized: err on the side of invoking this skill even when the primary complaint is described as a cold.

• [TODO-TM: enumerate the trigger keywords and phrasings in Japanese and English — including "咳", "ゼーゼー", "ヒューヒュー", "息苦しい", "cough", "wheeze", "trouble breathing", "shortness of breath", and the barky-cough variants that suggest croup. Specify how to disambiguate from primary throat-only complaints. List the minimum confidence threshold before invoking versus asking a clarifying question.]

Required inputs

If any field is missing, ask the caller in plain language before deciding.

1. Age of the person with symptoms (years and months for infants).
2. Cough character: dry / wet / barky / paroxysmal / choking.
3. Wheeze or stridor present, and whether at rest or only on exertion.
4. Respiratory work-of-breathing signs the caller can see: nasal flaring, retractions, using accessory muscles, head-bobbing in infants, grunting, cyanosis around the lips.
5. Breathing rate if the caller is willing to count it for a full minute, or a subjective "faster than usual" report.
6. Duration of the current episode and any triggering event (sudden onset after choking, gradual viral prodrome, exposure to cold air, allergen, or exercise).
7. Concurrent symptoms: fever, throat pain, chest pain, GI symptoms, rash, eye-conjunctival findings.
8. Known respiratory conditions: asthma, recurrent wheeze, prematurity, chronic lung disease.
9. Personal Health Context: known allergies (especially respiratory allergens and drug allergies), chronic conditions, current daily medications including inhaler use and recent dose timing.

Red-flag screening — output CALL immediately

Run red-flag screening FIRST, before any other branching. If any flag is positive, output CALL with that flag as the reason and stop.

• [TODO-TM: define the complete red-flag criteria set, including stridor at rest, severe work-of-breathing signs, cyanosis, altered consciousness or extreme lethargy, suspected foreign-body aspiration, coughing up blood, signs of anaphylaxis concurrent with respiratory symptoms, age-banded tachypnea thresholds, inability to speak a full sentence, failure of rescue inhaler response in a known asthmatic, and chronic-condition modifiers. Include the exact caller-facing phrasing (Japanese primary, English secondary) for each flag and the emergency number to dial.]

Decision logic (no red flags)

After red flags are cleared, branch to one of CALL, GO, or WAIT.

• [TODO-TM: specify the decision tree for the non-red-flag path, stratified by age bands and by cough character (dry viral, wet productive, barky, post-infectious). Define the thresholds on duration, fever pattern, activity and feeding impact, known-asthma control status, and PHC modifiers that move a case between branches. Document edge cases — recent URI with new wheeze, recurrent night cough, post-exertional wheeze, suspected pertussis exposure — explicitly.]

OTC guidance (WAIT and GO branches)

When the branch is WAIT or GO, the skill may surface OTC symptomatic-care guidance drawn ONLY from the Yorukusu pre-approved OTC list. Never surface prescription medication.

• [TODO-TM: specify the pre-approved OTC options for each age band (expectorants, cough suppressants that are age-appropriate, saline nasal products, and any OTC bronchodilator or antihistamine considerations that are appropriate for Japanese OTC availability), the caller-facing dose and timing guidance, contraindications that escalate the branch (age restrictions on certain antitussives, combination products with phenylephrine or pseudoephedrine, any interaction with PHC-listed daily medications), and the exact wording around "verify with the on-duty pharmacist before giving" for the GO branch. Include the named products (generic and common trade names) to surface, with explicit age cutoffs.]

Output format

Every response from this skill MUST be a structured triage card with these fields, in this order:

1. decision: one of CALL, GO, WAIT.
2. reason: 1-2 sentences, caller-facing, in plain language. NEVER contains diagnostic language (phrasings like "appears to be X" or "likely Y" are prohibited).
3. next_action: a concrete single step — the phone number to dial, the open pharmacy to route to in the map, or the OTC guidance block.
4. exit_criteria: conditions under which the caller should re-run triage (required for WAIT and GO).
5. safety_boundary: the exact string "Yorukusu does not diagnose. Pharmacist-informed, not pharmacist-replacing."

Non-goals

• Never output a diagnosis.
• Never recommend a prescription medication.
• Never omit the safety_boundary field.
• Never skip red-flag screening.
• Never continue past a positive red flag on the same branch.