Cough

INTRODUCTION

General pitfalls

• Attributing cough due to bronchial carcinoma in a smoker to ‘smoker’s cough’

• Overlooking TB, esp. in the elderly, by equating symptoms to old age, bronchitis or even smoking

• Overlooking the fact that bronchial carcinoma can develop in a patient with other pulmonary conditions such as chronic bronchitis

• Being slow to order a chest X-ray

KEY FEATURES

Key history Determine the nature of the cough, especially associated symptoms such as the nature of the sputum, breathlessness, wheezing and constitutional symptoms. Haemoptysis (adults): see Table C11. History of smoking habits, past and present, and occupational history are essential. Past history, especially respiratory and drug intake.

Key examination

• General examination, including a search for enlarged cervical or axillary glands

• Careful examination of the lungs and cardiovascular system with inspection of sputum

Key investigations

More applicable if haemoptysis.

• FBE/ESR/CRP

• Sputum cytology and culture

• Pulmonary function tests

• Plain CXR and other as appropriate

• Other tests (e.g. CT, bronchoscopy, ECG, echocardiogram, ventilation/perfusion scan, CT pulmonary angiogram), according to clinical findings

COUGH IN CHILDREN

Common causes are:

• asthma

• acute URTIs

• allergic rhinitis

• recurrent viral bronchitis

Disorders not to be missed are:

• asthma

• bronchiolitis; pneumonia, whooping cough

• cystic fibrosis

• inhaled foreign body

• tracheo-oesophageal fistula

Several clinicians describe the catarrhal child syndrome as the commonest cause of cough. This refers to children who develop a ...