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CLINICAL APPROACH
TO A PATIENT WITH
COUGH… HISTORY
TAKING
►Protectivemechanism
►Seeks MEDICAL CARE
 Discomfort from cough itself
 Interference with normal lifestyle
 Concern for cause of cough
HISTORY
1.Onset & Duration
  Acute :- URTI; pneumonia;
           aspiration; foreign body;

   pulmonary emboli; CHF
  Chronic :-COPD; bronchogenic CA;
            post nasal drip; asthma;
            GERD; TB; ILD;
            psychogenic
2.Character and timing
  Short,dry irritating cough with
   pain behind jaw or neck:-
                     Pharyngeal
   Harsh,irritative and repetitive
   with stridor and cyanosis:-
                     Laryngeal
Productive: amount; colour;
  consistency; smell
  Large amounts:-
a)regular coughing up-bronchiectasis
b)Single occasion-lung abcess,
                         empyema
c)Pink frothy-Pulm edema
Types of sputum

Types      Appearance     Cause

Serous     Clear,watery   A/c pulm
           frothy pink    edema
Mucoid     Clear grey-    C/c bronchitis,
           white viscid   COPD,Asthma
Purulent   Yellow/green   Bronchopulmona
                          ry infection
Rusty      Rusty,golden   Pneumococcal
           yellow         pneumonia
FROTHY SPUTUM
PURULENT SPUTUM
RUSTY SPUTUM
Foul smelling sputum- bronchiectasis,
             lung abcess, empyema

Solid matter present in viscid
 secretions in asthma, allergic
 brochopulmonary aspergillosis,
 necrotic tumour, foreign body
Haemoptysis;- C/c bronchitis,
 Bronchiectasis, Bronchogenic
 carcinoma, Pulmonary emboli,
 Pulmonary edema
3.Diurnal variation

Cough which gets worse in night and
 early morning :- Asthma

Persistent moist cough on waking up
 in smokers :- C/c bronchitis
4.Seasonal variation
Asthma, C/c bronchitis

5.Postural variation
  Bronchiectasis, Lung abcess,
6.Aggravating & Relieving factors

     Cold,smoke,dust,exertion:-
                           asthma
    Swallowing of liquids:- NM d/s
            of oropharynx

Otogenic cough:- impacted wax or
 foreign body in ext auditory meatus:
 …..subsides with removal of cause
7.Associated symptoms
  Fever:- RTI; lung abcess;
  Chest pain:-Bronchitis,
             bronchogenic carcinoma
  Pleuritic chest pain:-Pleurisy,
 pleural effusion,bronchiectasis
Dyspnoea:- COPD, Asthma, ILD,
 Pneumonia, Bronchogenic carcinoma,
 Sarcoidosis, CHF ( orthopnoea &
 PND)
Wheeze:- asthma
            “cough variant asthma”
Nasal discharge, tickling sensation in
 throat:- Postnasal drip
Loss of weight:- bronchogenic
                    carcinoma
Stridor:-FB,Laryngeal nerve
                    involvment
Hoarseness of voice:-Lary.N invlvmt
Heart burn, regurgitation:- GERD
Erythema nodosum:-Sarcoidosis
HISTORY OF PAST ILLNESS

COPD, Asthma, Postnasal drip, GERD
R/c or complicated Pneumonia,
 tuberculosis.whooping cough:-
 Bronchiectasis
Immunosuppression
Surgery ;bed rest

 BCG vaccination
Personal history

 Loss of appetite, sleep
 Smoking
 Occupational exposure
 Allergy or atopy
FAMILY HISTORY

 Chronic bronchitis with emphysema,
 Respiratory allergy, Asthma, Cystic
 fibrosis
 TB
TREATMENT HISTORY
 Angiotensin Converting
  Enzyme Inhibitors




 Past treatment of d/s like
 allergies,asthma,pneumonia,TB,Bron
 chitis
 Immunosuppressants
…DDs
1.Pneumonia:-fever, cough,dyspnoea,
    rigor,night sweats

2.Asthma:-episodic wheeze,dyspnea, c/c
  dry or productive cough worst at
  night,chest tightness

3.COPD:-persistent cough,large amount
  sputum,shortness of breath
4.Bronchiectasis:-c/c cough,copious
 amount of foul smelling sputum,
 hemoptysis,pleuritic chest pain,
 dyspnoea,loss of weight,anemia

5.Bronchogenic carcinoma:-new
 cough/change in cough,dyspnoea,
 hemoptysis,anorexia,loss of weight,
 chest pain
6.Tuberculosis:-cough
    (dry…purulent
   …blood streaks in
    sputum),
    anorexia,LOW,
   night sweats,
  evening rise of
   temperature
7.ILD:-insidous onset exertional
  dyspnoea,cough

8.CHF:-exertional dyspnoea,cough,
  fatigue,orthopnea.PND,edema
9.Sarcoidosis:-
 cough,dyspnoea,erythema nodosum,
 eye inflammation,fatigue,fever

10.Cystic fibrosis:-c/c or r/c cough
 with sputum,dyspnoea,wheeze,
 hemoptysis..young adult
11.Post nasal drip;-nasal discharge…
 mucoid or mucopurulent,tickle in
 throat

12.GERD:-cough,heart burns,
    regurgitation
13.Laryngeal inflammation:-cough,
 hoarseness of voice,stridor

14.FB:-cough,stridor,history

15.ACEI:-dry cough starting within
   1-6 months of treatment
…THANK YOU

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Clinical Approach to Cough History

  • 1. CLINICAL APPROACH TO A PATIENT WITH COUGH… HISTORY TAKING
  • 2. ►Protectivemechanism ►Seeks MEDICAL CARE Discomfort from cough itself Interference with normal lifestyle Concern for cause of cough
  • 3. HISTORY 1.Onset & Duration Acute :- URTI; pneumonia; aspiration; foreign body; pulmonary emboli; CHF Chronic :-COPD; bronchogenic CA; post nasal drip; asthma; GERD; TB; ILD; psychogenic
  • 4. 2.Character and timing Short,dry irritating cough with pain behind jaw or neck:- Pharyngeal Harsh,irritative and repetitive with stridor and cyanosis:- Laryngeal
  • 5. Productive: amount; colour; consistency; smell Large amounts:- a)regular coughing up-bronchiectasis b)Single occasion-lung abcess, empyema c)Pink frothy-Pulm edema
  • 6. Types of sputum Types Appearance Cause Serous Clear,watery A/c pulm frothy pink edema Mucoid Clear grey- C/c bronchitis, white viscid COPD,Asthma Purulent Yellow/green Bronchopulmona ry infection Rusty Rusty,golden Pneumococcal yellow pneumonia
  • 10. Foul smelling sputum- bronchiectasis, lung abcess, empyema Solid matter present in viscid secretions in asthma, allergic brochopulmonary aspergillosis, necrotic tumour, foreign body
  • 11. Haemoptysis;- C/c bronchitis, Bronchiectasis, Bronchogenic carcinoma, Pulmonary emboli, Pulmonary edema
  • 12. 3.Diurnal variation Cough which gets worse in night and early morning :- Asthma Persistent moist cough on waking up in smokers :- C/c bronchitis
  • 13. 4.Seasonal variation Asthma, C/c bronchitis 5.Postural variation Bronchiectasis, Lung abcess,
  • 14. 6.Aggravating & Relieving factors Cold,smoke,dust,exertion:- asthma Swallowing of liquids:- NM d/s of oropharynx Otogenic cough:- impacted wax or foreign body in ext auditory meatus: …..subsides with removal of cause
  • 15. 7.Associated symptoms Fever:- RTI; lung abcess; Chest pain:-Bronchitis, bronchogenic carcinoma Pleuritic chest pain:-Pleurisy, pleural effusion,bronchiectasis
  • 16. Dyspnoea:- COPD, Asthma, ILD, Pneumonia, Bronchogenic carcinoma, Sarcoidosis, CHF ( orthopnoea & PND) Wheeze:- asthma “cough variant asthma” Nasal discharge, tickling sensation in throat:- Postnasal drip
  • 17. Loss of weight:- bronchogenic carcinoma Stridor:-FB,Laryngeal nerve involvment Hoarseness of voice:-Lary.N invlvmt Heart burn, regurgitation:- GERD Erythema nodosum:-Sarcoidosis
  • 18. HISTORY OF PAST ILLNESS COPD, Asthma, Postnasal drip, GERD R/c or complicated Pneumonia, tuberculosis.whooping cough:- Bronchiectasis Immunosuppression Surgery ;bed rest BCG vaccination
  • 19. Personal history Loss of appetite, sleep Smoking Occupational exposure Allergy or atopy
  • 20. FAMILY HISTORY Chronic bronchitis with emphysema, Respiratory allergy, Asthma, Cystic fibrosis TB
  • 21. TREATMENT HISTORY Angiotensin Converting Enzyme Inhibitors Past treatment of d/s like allergies,asthma,pneumonia,TB,Bron chitis Immunosuppressants
  • 22. …DDs 1.Pneumonia:-fever, cough,dyspnoea, rigor,night sweats 2.Asthma:-episodic wheeze,dyspnea, c/c dry or productive cough worst at night,chest tightness 3.COPD:-persistent cough,large amount sputum,shortness of breath
  • 23. 4.Bronchiectasis:-c/c cough,copious amount of foul smelling sputum, hemoptysis,pleuritic chest pain, dyspnoea,loss of weight,anemia 5.Bronchogenic carcinoma:-new cough/change in cough,dyspnoea, hemoptysis,anorexia,loss of weight, chest pain
  • 24. 6.Tuberculosis:-cough (dry…purulent …blood streaks in sputum), anorexia,LOW, night sweats, evening rise of temperature
  • 25. 7.ILD:-insidous onset exertional dyspnoea,cough 8.CHF:-exertional dyspnoea,cough, fatigue,orthopnea.PND,edema
  • 26. 9.Sarcoidosis:- cough,dyspnoea,erythema nodosum, eye inflammation,fatigue,fever 10.Cystic fibrosis:-c/c or r/c cough with sputum,dyspnoea,wheeze, hemoptysis..young adult
  • 27. 11.Post nasal drip;-nasal discharge… mucoid or mucopurulent,tickle in throat 12.GERD:-cough,heart burns, regurgitation
  • 28. 13.Laryngeal inflammation:-cough, hoarseness of voice,stridor 14.FB:-cough,stridor,history 15.ACEI:-dry cough starting within 1-6 months of treatment