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Cough

 
 
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Overview

  • Cough is a non-specific symptom that may occur acutely or be present over a prolonged period of time. While cough often suggests pathology of the upper or lower airway, non-respiratory causes should also be considered.

Aetiology

    • Causes of Acute Cough

    • Infection - common cold, influenza, acute bronchitis, pneumonia, tuberculosis, whooping cough
    • Exacerbation of lung disease - asthma, COPD, bronchiectasis
    • Aspiration - fluid, vomitus or foreign body
    • Pulmonary oedema
    • Pulmonary embolus
    • Gastroesophageal reflux
    • Environmental pollutants
    • Causes of Chronic Cough

    • Common

    • Postnasal drip
    • Asthma
    • Chronic bronchitis (smoker’s cough)
    • Gastrooesophageal reflux
    • Postinfectious cough
    • ACE inhibitors
    • Uncommon

    • Bronchiectasis
    • Cystic fibrosis
    • Tuberculosis
    • Recurrent aspiration
    • Eosinophilic bronchitis
    • Environmental pollutants
    • Lung cancer - bronchial or parenchymal
    • Interstitial disease - pulmonary fibrosis, sarcoidosis
    • Mechanical - tracheobronchomalacia, airway strictures
    • Psychogenic - habitual cough, tic cough

History of Presenting Complaint

    • Character

      Whether the cough is moist, dry or productive.
    • Moist coughSuggestive of LRTI, COPD exacerbation or bronchiectasis
    • Dry CoughSuggestive of viral illness, asthma, GI reflux, restrictive lung disease or ACE inhibitors
    • Long paroxysms of ‘whooping’Suggestive of pertussis (whooping cough)
    • Sputum

      The colour, volume and consistency of the sputum.
    • Clear sputumNormal
    • Copious clear sputumSuggestive of bronchoalveolar carcinoma
    • Green sputumSuggestive of pneumonia or bronchiectasis
    • Rusty sputumCharacteristic of pneumococcal pneumonia
    • Redcurrant jelly sputumCharacteristic of Klebsiella pneumonia
    • Blood (haemoptysis)Suggestive of infection, chronic bronchitis, lung cancer or PE
    • Pink frothy sputumCharacteristic of pulmonary oedema
    • Offensively smelling sputumSuggestive of bronchiectasis, lung abscess or necrotizing pneumonia
    • Associated Symptoms

      Whether the cough is associated with any other symptoms.
    • FeversSuggestive of URTI or LRTI
    • Pleuritic chest painSuggestive of pneumonia, risk of PE
    • Heartburn or acidic tasteSuggestive of reflux-related cough
    • Shortness of breathNon-specific symptom of most causes
    • Chest pain and shortness of breathConcerning for PE
    • WheezeSuggestive of asthma, COPD or APO
    • Coryzal symptomsSuggestive of upper respiratory tract infection
    • Duration

    • Whether the cough has been going on for days, weeks, months or years.
    • Course

      The frequency & length of coughing episodes, and whether it varies throughout the day.
    • Worse in the morningCharacteristic of smoker’s cough (chronic bronchitis)
    • Worse at nightSuggestive of asthma or postnasal drip
    • Seasonal coughSuggestive of asthma
    • Exacerbating Factors

      Whether the cough is triggered by anything.
    • Exacerbated by environmental allergensSuggestive of asthma
    • Post-prandial coughReflux, aspiration
    • Recently started on an ACE inhibitorSuggestive of drug-induced cough
Last updated on November 11th, 2017
 
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