This document outlines the clinical approach to evaluating a patient presenting with cough, including taking a thorough history. Key aspects of the history include determining onset and duration of cough, characterizing the cough, examining sputum production, and identifying aggravating/relieving factors and associated symptoms. A detailed medical history including past illnesses, treatments, and family history is also important. Differential diagnoses that may cause cough include pneumonia, asthma, COPD, bronchiectasis, and lung cancer among others. A targeted history can help identify the underlying cause and guide appropriate management.

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

7. FROTHY SPUTUM

8. PURULENT SPUTUM

9. RUSTY SPUTUM

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

29. …THANK YOU