Cough
An awkward act in public during Covid season
Cough is a usual reflex from our throat where the reflex mechanism helps to expel mucus, irritant or any foreign material inspired into our airways down into the lung.
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Acute Cough is a common presentation in the general practice. Acute cough can be defined as cough that persists for less than 3 weeks duration. While chronic cough can be defined as cough that persists for more than 8 weeks. For adult patients seeking for medical care complaining of cough, it is suggested that the duration of cough during history taking is the primary step to narrow down the differential diagnosis’s lists.
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What are the red flags ?
If the patient present with haemoptysis, it might be suggestive of lung cancer or pulmonary oedema; if the patient is a smoker with coexisting voice disturbance or new changing emerging cough, malignancy should be suspected. If the patient has prominent dyspnoea during rest or during night-time, chronic obstructive pulmonary disease should be suspected. Furthermore, patient with night sweats and constitutional symptoms such as loss of weight and loss of appetite should be immediately related with pulmonary tuberculosis as a provisional diagnosis.
Causes of cough
1.Upper Respiratory Tract
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Common Cold
​Cough might persist for many weeks following an acute URTI as a result of persisting bronchial inflammation and increased airway responsiveness. It is usually manifested with non-productive cough, sore throat and rhinitis (including sneezing and running nose).
whooping cough
Patient presented with cough and coryza for one week followed by paroxysmal phase. Vomit may follow a cough spasm.
Allergic rhinitis
Together with the symptoms of sneezing, running nose, itch and eye irritation.
Postnasal drip
Commonest cause of persistent cough, especially nocturnal cough due to secretion tracking down the larynx and trachea during sleep.
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Laryngeal cancer
Usually, the patient presented with history of chronic laryngitis, smoking and alcohol use. Symptoms include hoarseness, stridor, haemoptysis, and dysphagia.​
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2.Lower Respiratory Tract
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Cough variant asthma
Dry, non-productive cough. Patients with cough-variant asthma often have no other "classic" asthma symptoms, such as wheezing or shortness of breath.​​
Acute bronchitis
Commonest cause of cough together with URTI. Features are mainly productive cough, wheeze and shortness of breath. Generally self-limiting but might be serious in debilitated patients.
Pneumonia​
Usually presents as an acute illness with cough, fever and purulent sputum.
Initial presentation might be misleading especially when the patient is presented with constitutional symptoms such as fever, malaise and headache rather than respiratory symptoms.
Bronchiectasis
Chronic coughs worsen on waking, with yellowish or greenish sputum only after infection. Sputum production is related to posture. Advanced bronchiectasis might present with profuse purulent offensive sputum, persistent halitosis, recurrent febrile episodes, malaise and weight loss
Chronic obstructive pulmonary disorder (COPD)
Main symptoms are increasing breathlessness, cough and sputum production.
Bronchial carcinoma
Chronic cough with smoking history and constitutional symptoms. Accounts for over 95% of primary lung malignancies.
Aspiration
Foreign body aspiration in children
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3. Cardiovascular System
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Congestive heart failure. Persistent cough or wheezing with white or pink blood-tinged mucus, associated with shortness of breath with activity or when lying down. Other manifestation are fatigue and weakness, pedal oedema, reduced effort tolerance.
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Pulmonary embolism. A sudden persistent haemoptysis and is a medical emergency.
5. Psychological condition
Cough without obvious medical aetiology.
4. Gastrointestinal System
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Gastroesophageal reflux disease (GERD)
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Patients usually present with persistent, non-productive aspiration cough with a history of acid reflux.
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The most common symptom of GERD is heartburn (acid indigestion), often worse after eating, lying down or bending over and relieved by taking antacids.​​
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6. Drug induced
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Angiotensin-converting enzyme inhibitors (ACEIs)
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Elevated bradykinin causing activation of pro-inflammatory peptides, causing airways irritation, triggering inflammation and coughing.
Reference:
S.S., Mery Fitzgerald Hospital, M.F.H., & National Health Service. (2021, August 14). Cough. StatPearls.
https://www.ncbi.nlm.nih.gov/books/NBK493221/
Murtagh J, Rosenblatt J, Coleman J, Murtagh C. Murtagh J, & Rosenblatt J, & Coleman J, & Murtagh C(Eds.),Eds. John Murtagh, et al. (2018).