Specific chronic cough "pointer" | Possible major underlying etiology |
History | |
Pulmonary symptoms | |
| Suppurative lung diseases (protracted bacterial bronchitis, chronic suppurative lung disease, bronchiectasis), aspiration, abscess, cavitations |
| Infection (eg, tuberculosis), interstitial lung disease, bronchiectasis, autoimmune lung disease |
| Asthma (if no other specific cough pointer present other than spirometry, and dyspnea that responds to bronchodilators); bronchiectasis, eosinophilic disorders (if other specific cough pointer[s] present) |
| Asthma or any severe lung disease |
| These cough characteristics (eg, barking, honking, whooping) often suggest a specific cause of cough¶ |
| Immunodeficiency, obstructed airways or any conditions causing bronchiectasis |
Timing and triggers | |
| Congenital abnormality related to airways, immune function, or causes with predisposition to bronchiectasis (eg, primary ciliary dyskinesia) |
| Inhaled retained foreign body |
| Habit cough (tic cough) |
| Somatic cough disorder (psychogenic cough) |
| Progressive cough (getting worse) warrants further investigation for specific causes A subsiding cough is usually nonspecific and will likely resolve spontaneously A cough that is initially stable (neither progressive nor subsiding) may subsequently follow either of these trajectories |
Associated symptoms or conditions | |
| Primary cardiac disease causing cough, tracheomalacia or primary ciliary dyskinesia |
| Aspiration |
| Laryngeal or trachea disorders, aspiration |
| Any severe lung disease, cystic fibrosis, immunodeficiency, indolent infections (eg, tuberculosis) |
| Tuberculosis and other mycobacterium, pertussis, parasites (eg, Toxocara), and/or zoonoses (eg, trematodes, Strongyloides, Q fever) |
| Opportunistic infections (eg, fungal) |
| Interstitial lung disease |
| Known adverse effect of angiotensin-converting enzyme inhibitor |
| Indolent infection with or without immunodeficiency |
Examination | |
Digital clubbing | Bronchiectasis or interstitial lung disease |
Chest wall abnormality | Any lung disease, neuromuscular disease |
Wheezing or crepitations | Any lung disease; in particular, asthma, bronchiolitis obliterans, bronchiectasis (from any cause), bronchopulmonary dysplasia, heart failure, immunodeficiency and aspiration |
Hypoxia | Any lung disease |
Routine investigations/tests | |
Abnormal chest radiography | Any lung disease |
Abnormal spirometry | Obstructive or restrictive lung/chest wall diseases |
* In young children, wet cough is substituted for productive cough.
¶ Classically recognized characteristics are a cough that sounds barking/brassy, honking, paroxysmal/whooping, or staccato or that produces casts. Refer to separate table on classically recognizable cough sounds for details.Do you want to add Medilib to your home screen?