Chapter 42

### Introduction

I bounded into bed. The bound made me cough—I spat—it tasted strange—it was bright red blood—I don’t want to find this is real consumption—I shan’t have my work written. That’s what matters. How unbearable it would be to die—nothing real finished.

Katherine Mansfield (1888–1923), Diary entry 1918

Cough is one of the five most common symptoms presenting in family practice. There is a wide range of causes (see Table 42.1) with the great majority being minor and self-limiting, although the possibility of serious causes such as bronchial carcinoma should always be kept in mind.

Table 42.1

Significant causes of cough

It is a feature of smokers, who often have a morning cough with little sputum. Coughing can also be initiated by pleural irritation. It is a reflex that provides an essential protective service. It serves to remove substances that may have been accidentally inhaled and removes excess secretions or exudates that may accumulate in the airway.

Key facts and checkpoints

• Cough is the commonest manifestation of lower respiratory tract infection.

• Cough is the cardinal feature of chronic bronchitis.

• Cough is a feature of asthma with sputum production, especially at night.

• Cough can have a psychogenic basis.

• Cough may persist for many weeks following an acute upper respiratory tract infection (URTI) as a result of persisting bronchial inflammation and increased airway responsiveness.1

• Postnasal drip is the commonest cause of a persistent or chronic cough, especially causing nocturnal cough due to secretions (mainly from chronic sinusitis) tracking down the larynx and trachea during sleep.

• The commonest causes of haemoptysis are URTI (24%), acute or chronic bronchitis (17%), bronchiectasis (13%), TB (10%). Unknown causes totalled 22% and cancer 4% (figures from a UK study).2

### A diagnostic approach

A summary of the diagnostic strategy model is presented in Table 42.2.

Table 42.2

Cough: diagnostic strategy model

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