Table 1 Questions to be addressed to arrive at a specific diagnosis for acute cough
QuestionFeaturesLikely common diagnoses
Is this an acute upper respiratory infection?Coryzal symptomsSimple head cold with cough suggesting presence of some degree of tracheitis and/or bronchitis
Is this a croup syndrome?Stridor with an associated “barking” or “croupy cough”. In milder cases only the barking cough may be presentViral croupRecurrent spasmodic croupBacterial tracheitis†
Are there any features to suggest a lower respiratory tract illness?Tachypnoea*, respiratory distress with increased work of breathing, chest signs (crackles/wheeze) and feverPneumonia‡Bronchiolitis§Asthma¶
Is there anything to suggest an inhaled foreign body?Very sudden onset or witnessed choking episodeInhaled foreign body. Bronchoscopy is indicated on history alone to diagnose and remove it.
Is there anything to suggest acute pollinosis (hay fever)?Cough with other features of “hay fever” in pollen season. This cough is often described as a “clearing the throat” coughAllergic rhinitis coughTrue coughing may suggest allergic tracheobronchial inflammation
Is there anything to suggest that this is a presentation of a chronic respiratory disorder?Failure to thrive, finger clubbing, over inflated chest, chest deformity, features of atopySee chronic cough section
  • *The respiratory rate varies with age and tachypnoea is defined as a respiratory rate of >60/min for children aged <2 months, >50/min for those aged 2–12 months and >40/min for children aged >1 year.

  • †Bacterial tracheitis is an uncommon but life-threatening condition in which children have a high temperature and progressive upper airways obstruction. The croupy cough helps to distinguish it from epiglottitis. These children usually need their airway secured and intravenous antibiotics to cover Staphylococcus aureus, Haemophilus influenzae B and streptococcal infections.

  • ‡Pneumonia is suggested if there is cough, fever and signs of respiratory distress in the absence of stridor or wheeze.

  • §Bronchiolitis is suggested in an infant with cough associated with crepitations, with or without audible wheeze during the winter respiratory syncytial virus season.

  • ¶Asthma is suggested if cough is associated with wheezing.