Cough

Differential diagnosis

  • Respiratory
    • Lung Ca – weight loss, haemoptysis
    • Infection – change in sputum, fevers, AMTS, CURB-65
    • Bronchiectasis – persistent productive cough over months
    • Asthma – night time, atopic, typical triggers (exercise, cold, season)
    • COPD – smoker, chronic productive cough, SOB
    • PE – chest pain, haemoptysis
  • Cardiovascular
    • CCF – orthopnoea, PND
  • GI
    • GORD – dyspepsia, association with food/lying down
  • Other
    • Post nasal drip – atopic
    • Foreign body – child
    • Medications
    • Atypical infections (TB, PCP) – travel, sexual history, immunosuppressants
    • Asbestosis – occupational exposure

 

Data gathering

  • History
    • as above
  • Examination
    • Obs: Temperature, RR, HR, Sats, BP
    • General: Respiratory distress
    • Respiratory, CVS, Legs
    • ENT

 

Clinical Management

  • Investigations
    • Bloods
    • Sputum MC&S
    • CXR
    • ECG
    • Lung function testing
  • Treatment
    • as per condition
  • Follow-up / Safety-net

 

Note

  • Average length of common illnesses:
    • acute otitis media: 4 days
    • acute sore throat: 1 week
    • common cold: 1.5 weeks
    • acute rhinosinusitis: 2.5 weeks
    • acute cough: 3 weeks
  • Consider immediate antibiotics
    • systemically unwell
    • symptoms not settling in accordance with expected course
    • recent hospitalisation
    • current use of oral steroids
    • diabetes
    • significant heart, lung, renal, liver, neuromuscular disease, immunosuppression, CF, premature children