Some Causes of Cough
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Acute Cough | ||
Foreign body* | Sudden onset in a young child who has no URI or constitutional symptoms | Chest radiograph (inspiratory and expiratory views) Bronchoscopy |
Dyspnea Fine inspiratory crackles Extrasystolic heart sound Elevated jugular venous pressure Dependent peripheral edema Orthopnea Paroxysmal nocturnal dyspnea | Chest radiograph 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 Inspiratory crackles Hypoxia on pulse oximetry | Chest radiograph Cultures (eg, sputum, pleural fluid, blood, possibly bronchial washings) in seriously ill patients and patients with hospital-acquired pneumonia Multiplex PCR panel |
Postnasal drip (allergic or infectious origin)‡ | Headache Sore throat Nausea Cobblestoning of posterior oropharynx Pale, boggy, swollen nasal mucosa Frequent clearing of the throat | History and physical examination Response to empiric antihistamine, decongestant, or nasal ipratropium therapyResponse to empiric antihistamine, decongestant, or nasal ipratropium therapy CT of the sinuses if diagnosis is unclear |
Pleuritic chest pain Dyspnea Tachycardia | CT angiography Less often, ventilation/perfusion scanning and possibly pulmonary arteriography | |
URI, including acute bronchitis† | Rhinorrhea Red, swollen nasal mucosa Sore throat Malaise | History and physical examination |
Chronic Cough | ||
ACE inhibitors | Dry, persistent nocturnal cough that may occur within days or months after initiation of ACE inhibitor therapy | Gauging clinical response to stopping ACE inhibitor |
Aspiration | Cough after eating or drinking Wheezing | Chest radiograph Sometimes modified barium pharyngography Bronchoscopy |
Asthma (including cough variant) | Cough in response to various precipitating factors (eg, allergens, cold air, exercise, viral infection) Possibly wheezing and dyspnea | Pulmonary function testing Methacholine challenge Response to empiric bronchodilator therapy |
Chronic bronchitis (a subset of COPD)‡ | 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 radiograph 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 | History and physical examination Pulmonary function testing Imaging of the chest (radiograph or CT) |
Burning chest or abdominal pain that tends to worsen with consumption of certain foods, certain activities, or certain positions Sour taste, particularly on awakening Halitosis 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 radiograph |
Interstitial lung disease | Dyspnea of gradual onset Dry cough Inspiratory crackles History of drug (medication or illicit)§ or occupational exposure | Chest radiograph High-resolution CT Pulmonary function testing |
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 | |
Rhinosinusitis‡ | Headache Sore throat Cobblestoning of posterior oropharynx Pale, boggy, swollen nasal mucosa | History and physical examination Response to empiric antihistamine or decongestant therapy Sometimes allergy testing |
Tuberculosis (TB) Fungal infections | Atypical symptoms (eg, weight loss, fever, hemoptysis, night sweats) Exposure history Immunocompromise (eg, use of TNF inhibitors) | Chest radiograph Tuberculin skin testing or interferon gamma release assay; if positive, sputum cultures and stains for acid-fast bacilli and fungi Sometimes chest CT or bronchoalveolar lavage |
Atypical symptoms (eg, weight loss, low-grade fever, hemoptysis, night sweats) Change in chronic cough Lymphadenopathy | Chest radiograph If positive, chest CT and bronchoscopic biopsy | |
* Indicates rare causes of cough. | ||
† Streptococcal pharyngeal infections notably may not cause cough. | ||
‡ Also a cause of subacute cough. | ||
§ See table Substances With Toxic Pulmonary Effects. | ||
ACE = angiotensin-converting enzyme; CT = computed tomography; PCR = polymerase chain reaction; TB = tuberculosis; TNF = tumor necrosis-factor; URI = upper respiratory infection. | ||