Some Causes of Cough
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Acute Cough | ||
Foreign body* | Sudden onset in a toddler who has no URI or constitutional symptoms | Chest x-ray (inspiratory and expiratory views) Bronchoscopy |
Dyspnea Fine crackles Extrasystolic heart sound Elevated jugular venous pressure Dependent peripheral edema Orthopnea Paroxysmal nocturnal dyspnea | Chest x-ray Brain (B-type) natriuretic peptide level Transthoracic echocardiography | |
Pneumonia (viral, bacterial, aspiration, rarely fungal) | Fever Productive cough Dyspnea Pleuritic chest pain Localized bronchial breath sounds or egophony | Chest x-ray Cultures (eg, sputum, pleural fluid, blood, possibly bronchial washings) in seriously ill patients and patients with hospital-acquired pneumonia |
Postnasal drip (allergic, viral, or bacterial origin) | Headache Sore throat Nausea Cobblestoning of posterior oropharynx Pale, boggy, swollen nasal mucosa Frequent clearing of the throat | Clinical evaluation CT of the sinuses if diagnosis is unclear |
Pleuritic chest pain Dyspnea Tachycardia | CT angiography Less often, ventilation/perfusion scanning and possibly pulmonary arteriography | |
Upper respiratory infection (URI), including acute bronchitis | Rhinorrhea Red, swollen nasal mucosa Sore throat Malaise | Clinical evaluation |
Chronic Cough | ||
Angiotensin-converting enzyme (ACE) inhibitors | Dry, persistent cough that may occur within days or months after initiation of ACE inhibitor therapy | Response to stopping ACE inhibitor |
Aspiration | Cough after eating or drinking | Chest x-ray Sometimes modified barium pharyngography Bronchoscopy |
Asthma (cough variant) | Cough in response to various provoking factors (eg, allergens, cold, exercise) Possibly wheezing and dyspnea | Pulmonary function testing Methacholine challenge Response to empiric bronchodilator therapy |
Chronic bronchitis (in patients who smoke) | Productive cough on most days of the month or for 3 months of the year for 2 successive years in a patient with known COPD or smoking history Frequent clearing of the throat Dyspnea | Chest x-ray Pulmonary function testing |
COPD (chronic obstructive pulmonary disease) | Known diagnosis of COPD Decreased breath sounds Wheezing Dyspnea Pursed lip breathing Use of accessory respiratory muscles Tripod positioning of the arms against the legs or examination table | Clinical evaluation |
Burning chest or abdominal pain that tends to worsen with consumption of certain foods, certain activities, or certain positions Sour taste, particularly on awakening Hoarseness Chronic nocturnal or early morning cough | Response to empiric H2 blocker or proton pump inhibitor therapy Sometimes esophageal manometry or pH probe | |
Hyperresponsive airways after resolution of respiratory tract infection | Dry, nonproductive cough that may persist for weeks or months after an acute respiratory tract infection | Typically chest x-ray |
Interstitial lung disease | Shortness of breath of gradual onset Dry cough History of drug or occupational exposure | Chest x-ray High-resolution CT |
Repeated bouts of ≥ 5 rapidly consecutive, forceful coughs during a single expiration, followed by a hurried and deep inspiration (whoop) or posttussive emesis | Cultures of nasopharyngeal specimens | |
Postnasal drip | Headache Sore throat Cobblestoning of posterior oropharynx Pale, boggy, swollen nasal mucosa | Clinical evaluation Response to empiric antihistamine or decongestant therapy Sometimes allergy testing |
Tuberculosis (TB) or fungal infections* | Atypical symptoms (eg, weight loss, fever, hemoptysis, night sweats) Exposure history Immunocompromise | Chest x-ray Skin testing; if positive, sputum cultures and stains for acid-fast bacilli and fungi Sometimes chest CT or bronchoalveolar lavage |
Atypical symptoms (eg, weight loss, fever, hemoptysis, night sweats) Change in chronic cough Lymphadenopathy | Chest x-ray If positive, chest CT and bronchoscopic biopsy | |
* Indicates rare causes of cough. | ||