Table 5 Questions to address in cough evaluation
How did the cough start?Very acute onsetRetained inhaled foreign body
Head coldInfective cause (eg, postviral)
When did the cough start?Neonatal onset (especially if in first few days of life)Aspiration
Congenital malformation
Cystic fibrosis
Primary cilial dyskinesia
Lung infection in utero
What is the quality of the cough?Productive (“moist or wet”)Chronic suppurative lung disease (bronchiectasis) eg, cystic fibrosis
Paroxysmal spasmodic cough with or without an inspiratory “whoop” and vomitPertussis or pertussis-like illness
HaemoptysisCystic fibrosis
Other bronchiectasis
Retained inhaled foreign body
Pulmonary haemosiderosis
Pulmonary arteriovenous malformation
“Bizarre honking cough” in a child exhibiting “la belle indifference” to the cough and which increases with attentionPsychogenic cough
Dry repetitive cough, disappears with sleepHabit cough
Brassy, barking or “seal-like”Tracheal or glottic cause (eg, tracheomalacia and/or bronchomalacia)
Cough producing casts of the airwaysPlastic bronchitis
Is the cough relentlessly progressive?Inhaled foreign body
Lobar collapse
Rapidly expanding intrathoracic lesion
Is the cough an isolated symptom?Isolated cough (otherwise well)Non-specific isolated cough
Recurrent viral bronchitis
Psychogenic cough
Associated wheezing presentAsthma
Retained inhaled foreign body
Recurrent pulmonary aspiration
Airways compression or tracheobronchomalacia
Bronchiolitis obliterans or interstitial lung disease
Neonatal chronic lung disease and rarely
Cardiac disease with either congestive heart failure or large left to right shunts
Associated ill health, recurrent pneumonia or pulmonary infiltratesCystic fibrosis
Immune deficiencies
Primary cilial disorders
Recurrent pulmonary aspiration
Retained inhaled foreign body
Persistent bacterial bronchitis
Anatomical disorder
Associated shortness of breath and restrictive lung defectInterstitial lung disease
What triggers the cough?Exercise, cold air, early morningAsthma
Lying downPostnasal drip, gastro-oesophageal reflux disease
FeedingRecurrent pulmonary aspiration