Cough Causes & Treatment / cough diagnosis and management

Acute < 3 week

Persistent 3-8 week

Chronic > 8 week

Causes of cough / cough diagnosis

Acute: Laryngitis, Pneumonia, Tracheitis, acute bronchitis, infections of respiratory tract.

Chronic: Chronic laryngitis, bronchiectasis, ILD, tuberculosis, chronic bronchitis, bronchial asthma.

Persistent: COPD in smokers, viral bronchial infections, asthma, bronchial carcinoma, PTB, fibrosis.

Mechanical irritation: smokers, foreign body.

Dry cough: early PTB, smokers cough, ILD, acute tracheobronchitis, ACE inhibitors, chronic pharyngitis, asthma, tropical eosinophilia.

Psychogenic: Insanity, mental/emotional.

Nocturnal cough: Left ventricular failure, Post-nasal drip, aspiration, bronchial asthma, tropical eosinophilia.

Painful: Pleurisy (pneumonia, pleural effusion), trauma.

Occupation, dust: Pneumoconiosis.

postural change: Lung abscess, GERD, bronchiectasis, .

Eating or drinking: Tracheoesophageal Esophageal fistula, esophageal reflux.

Character

Croupy cough: Laryngitis, diphtheria.

Barking cough: Acute epiglottitis.

Harsh, barking, painful with stridor: Laryngitis, laryngeal tumor.

Loud and brassy cough: Pressure on trachea (by tumor).

Hollow, bovine: Recurrent laryngeal nerve palsy (commonly due to bronchial carcinoma).

Associated with whoop: Whooping cough.Cough with wheeze: Bronchial asthma, COPD.

Expectoration findings

Profuse expectoration: Pneumonia, bronchiectasis, lung abscess.

Rusty sputum: Pneumococcal pneumonia.

Frothy sputum: Pulmonary edema.

Yellowish: Pneumonia.

Foul smelling : Lung abscess.

Hemoptysis

PTB, acute bronchitis, bronchial carcinoma, bronchiectasis, mitral stenosis, DIC, anticoagulant, aspirin ( or antiplatelet), hemophilia

Cough differential diagnosis

Cough in HIV

Productive in bacterial pneumonia. Pneumocystis- dry cough and dyspnea. Pleuritic chest pain in spontaneous pneumothorax in Kaposi Pneumocystis. hemoptysis in tuberculosis.

Thermal

Inhalation of cold air, especially in patients who have reactive airways and in those who are

exercising, may cause coughing or wheezing.

Fume inhalation

Volatile chemical inhalation, tobacco, smoke.

Pertussis

loud inspiratory whoop and mucous expectoration.

Upper respiratory viral infection

Irritative cough, wheezing, scratchy sore throat, nasal congestion,

Sinusitis

Mucous in the pharynx, maxillary fullness/tenderness, purulent nasal discharge.

Mycoplasma bronchitis

Dry, hacking cough to productive, fever helpful. Bullous myringitis.

Pneumonia

Fever, rigors, productive cough, pleuritic chest pain, dyspnea, rusty sputum in pneumococcus.

Gastroesophageal reflux(GERD)

Heartburn, night cough.

Congestive heart failure

Left heart failure, dry cough, tachycardia, fine basal rales, exertional dyspnea, orthopnea.

S3 gallop.

ACE inhibitor

An irritative, nonproductive cough coincides temporally with the use of the drug.

Aspiration

Unilateral wheezing, foreign body aspiration.

Cough Causes & Treatment / cough diagnosis and management / cough treatment

Avoid dust, smoke, allergens, cold.

Dry cough syrup: Dextromethorphan/ Codeine/ Chlorpheniramine/ diphenhydramine.

Productive cough syrup: Guaiphenesin/ Bromhexine/ ambroxol.

Bronchodilator: salbutamol, terbutalin.

Specific treatment:

H1N1: Cap. Oseltamivir 75 mg BD adult.

COPD: Antibiotics (Azithromycin 500mg OD), O2 inhalation, nebulisation, Brochodilators, steroids.

PTB: ATT.

Stop drugs like ACEi, ARB, etc.

Asthma: O2 inhalation, nebulisation, Brochodilators, steroids.

Pneumonia: Azithromycin 500mg OD/ Levofloxacin 500/750 mg OD.

Heart failure: Diuretics, ARNI (sacubitril/valsartan), supportive care.

Gastroesophageal reflux(GERD): Stop fatty/ spicy food, chocolate, tomatoes, citrus, cofee, Cap. Pantoprazole 40 mg OD, surgical fundoplication, etc.

Cough Causes & Treatment