Cough
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
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