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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.


  • 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
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