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Reliable, easy-to-read patient information on common medical conditions β€” written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Chronic cough

Introduction

Chronic Cough Differential Diagnosis

Chronic Cough Differential Diagnosis

Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
Respiratory Upper airway diseases Laryngopharyngeal reflux_American_Academy_of_Otolaryngology-Head_and_Neck_Surgery-1|[1][2] Chronic
  • Variable
 + βˆ’ βˆ’ βˆ’ +
  • Normal function
  • 24 hourβˆ’dual sensor pH probe
Rhinosinusitis[3][4] Acute, subacute, chronic, recurrent
  • Acute: Less than 4 weeks
  • Subacute: 4βˆ’12 weeks
  • Chronic: More than 12 weeks
  • Recurrent: 4 or more episodes or acute rhinosinusitis per year
 + βˆ’ βˆ’ + +
  • Clear chest
  • Airβˆ’fluid level, mucosal edema and bony erosion of sinus on CT
  • MRI for distinguish the etiology
  • Normal function
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
Respiratory Lower airway Asthma[5] Chronic
  • Years
 + Clear mucoid or yellow sputum βˆ’ βˆ’ βˆ’ +
  • Family history
  • Seasonal variation
Chronic Bronchitis[6][7] Chronic
  • Most of the days for three months in the las two years.
 + Clear sputum βˆ’ βˆ’ + +
Nonβˆ’asthmatic eosinophilic bronchitis[8][9] Chronic
  • More than 8 weeks
 + Eosinophilic sputum βˆ’ βˆ’ βˆ’ +
  • Exposure to an occupational cause
Bronchiectasis[10] Chronic
  • Months to years
 + Mucopurulent sputum + βˆ’ βˆ’ +
  • CT of chest
Emphysema [11] Chronic
  • Months to years
 + Mucoid or purulent sputum βˆ’ βˆ’ + +
  • Exposure of tobacco and air pollution
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
Respiratory Parenchyma Pneumoconioses[12][13] Acute, Chronic
  • Years
 βˆ’ βˆ’ + + +
Lung cancer[14][15] Chronic
  • Years
 + + + +/βˆ’ + The following investigations may be helpful:
  • Not specific
Interstitial lung disease[16][17] Chronic
  • Variable
 βˆ’ + + βˆ’ + The following investigations may be helpful:
  • Lung biopsy when lab, imaging, and PFT has indeterminate result
Tuberculosis (TB)[18][19] Chronic
  • More than 2 or 3 weeks
 + + + + +
Cystic fibrosis (CF)[20][21] Chronic
  • Variable
 + βˆ’ + +/βˆ’ +
  • Evidence of CFTR dysfunction
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
[[[Heart|Cardiac]] Mitral Stenosis[22][23] Chronic
  • Variable
 + Pink frothy + βˆ’ βˆ’ +
  • Not specifc
Pulmonary hypertension[24][25] Chronic
  • More than 2 years
 βˆ’ + + βˆ’ + The following investigations may be helpful:
Gastrointestinal Gastroesophageal reflux[26][27] Chronic
  • Variable
 + βˆ’ + βˆ’ +
  • Not specific
  • Normal function
  • PH testing
 βˆ’βˆ’
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
Autoimmune Goodpasture syndrome[28][29] Chronic
  • Variable
 βˆ’ + βˆ’ βˆ’ + The following investigations may be helpful:
Wegener’s disease (GPA) [30][31] Chronic
  • Months
 + + + + + The following investigations may be helpful:
Sarcoidosis[32][33] Chronic
  • Years
 βˆ’ βˆ’ + + + The following investigations may be helpful:
Microscopic polyangitis (MPA)[34] Chronic
  • Variable
 + + + + + The following investigations may be helpful:
Churgβˆ’Strauss[35][36] Chronic
  • Variable
 + + + + +
  • Infiltrates in chest Xβˆ’Ray
  • Ground glass opacities, treeβˆ’inβˆ’bud sign and small nodules in chest CT
References

References

  1. _American_Academy_of_Otolaryngology-Head_and_Neck_Surgery_1-0|↑ “What is LPR? | American Academy of Otolaryngology-Head and Neck Surgery”.
  2. ↑ Noordzij JP, Khidr A, Desper E, Meek RB, Reibel JF, Levine PA (2002). “Correlation of pH probe-measured laryngopharyngeal reflux with symptoms and signs of reflux laryngitis”. Laryngoscope. 112 (12): 2192–5. doi:10.1097/00005537-200212000-00013. PMIDΒ 12461340.
  3. ↑ Meltzer EO, Hamilos DL (2011). “Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines”. Mayo Clin Proc. 86 (5): 427–43. doi:10.4065/mcp.2010.0392. PMCΒ 3084646. PMIDΒ 21490181.
  4. ↑ Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MD (2015). “Clinical practice guideline (update): adult sinusitis”. Otolaryngol Head Neck Surg. 152 (2 Suppl): S1–S39. doi:10.1177/0194599815572097. PMIDΒ 25832968.
  5. ↑ Ukena D, Fishman L, Niebling WB (2008). “Bronchial asthma: diagnosis and long-term treatment in adults”. Dtsch Arztebl Int. 105 (21): 385–94. doi:10.3238/arztebl.2008.0385. PMCΒ 2696883. PMIDΒ 19626179.
  6. ↑ Brusasco V, Martinez F (2014). “Chronic obstructive pulmonary disease”. Compr Physiol. 4 (1): 1–31. doi:10.1002/cphy.c110037. PMIDΒ 24692133.
  7. ↑ Qaseem A, Snow V, Shekelle P, Sherif K, Wilt TJ, Weinberger S, Owens DK (2007). “Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians”. Ann. Intern. Med. 147 (9): 633–8. PMIDΒ 17975186.
  8. ↑ Brightling CE (2006). “Chronic cough due to nonasthmatic eosinophilic bronchitis: ACCP evidence-based clinical practice guidelines”. Chest. 129 (1 Suppl): 116S–121S. doi:10.1378/chest.129.1_suppl.116S. PMIDΒ 16428700.
  9. ↑ Cho J, Choi SM, Lee J, Park YS, Lee SM, Yoo CG; et al. (2018). “Clinical Outcome of Eosinophilic Airway Inflammation in Chronic Airway Diseases Including Nonasthmatic Eosinophilic Bronchitis”. Sci Rep. 8 (1): 146. doi:10.1038/s41598-017-18265-2. PMCΒ 5760521. PMIDΒ 29317659.
  10. ↑ King PT, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW (2006). “Characterisation of the onset and presenting clinical features of adult bronchiectasis”. Respir Med. 100 (12): 2183–9. doi:10.1016/j.rmed.2006.03.012. PMIDΒ 16650970.
  11. ↑ Rossi A, Butorac-Petanjek B, Chilosi M, CosΓ­o BG, Flezar M, Koulouris N; et al. (2017). “Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research – a consensus document from six scientific societies”. Int J Chron Obstruct Pulmon Dis. 12: 2593–2610. doi:10.2147/COPD.S132236. PMCΒ 5587130. PMIDΒ 28919728.
  12. ↑ Jp NA, Imanaka M, Suganuma N (2017). “Japanese workplace health management in pneumoconiosis prevention”. J Occup Health. 59 (2): 91–103. doi:10.1539/joh.16-0031-RA. PMCΒ 5478517. PMIDΒ 27980247.
  13. ↑ Weiland DA, Lynch DA, Jensen SP, Newell JD, Miller DE, Crausman RS, Kuhn C, Kern DG (2003). “Thin-section CT findings in flock worker’s lung, a work-related interstitial lung disease”. Radiology. 227 (1): 222–31. doi:10.1148/radiol.2271011063. PMIDΒ 12668748.
  14. ↑ Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011). “Global cancer statistics”. CA Cancer J Clin. 61 (2): 69–90. doi:10.3322/caac.20107. PMIDΒ 21296855.
  15. ↑ Ost DE, Jim Yeung SC, Tanoue LT, Gould MK (2013). “Clinical and organizational factors in the initial evaluation of patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines”. Chest. 143 (5 Suppl): e121S–e141S. doi:10.1378/chest.12-2352. PMCΒ 4694609. PMIDΒ 23649435.
  16. ↑ Lama VN, Martinez FJ (2004). “Resting and exercise physiology in interstitial lung diseases”. Clin. Chest Med. 25 (3): 435–53, v. doi:10.1016/j.ccm.2004.05.005. PMIDΒ 15331185.
  17. ↑ Chetta A, Marangio E, Olivieri D (2004). “Pulmonary function testing in interstitial lung diseases”. Respiration. 71 (3): 209–13. doi:10.1159/000077416. PMIDΒ 15133338.
  18. ↑ Perlman DC, el-Sadr WM, Nelson ET, Matts JP, Telzak EE, Salomon N, Chirgwin K, Hafner R (1997). “Variation of chest radiographic patterns in pulmonary tuberculosis by degree of human immunodeficiency virus-related immunosuppression. The Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). The AIDS Clinical Trials Group (ACTG)”. Clin. Infect. Dis. 25 (2): 242–6. PMIDΒ 9332519.
  19. ↑ Barnes PF, Verdegem TD, Vachon LA, Leedom JM, Overturf GD (1988). “Chest roentgenogram in pulmonary tuberculosis. New data on an old test”. Chest. 94 (2): 316–20. PMIDΒ 2456183.
  20. ↑ Farrell PM, Rosenstein BJ, White TB, Accurso FJ, Castellani C, Cutting GR, Durie PR, Legrys VA, Massie J, Parad RB, Rock MJ, Campbell PW (2008). “Guidelines for diagnosis of cystic fibrosis in newborns through older adults: Cystic Fibrosis Foundation consensus report”. J. Pediatr. 153 (2): S4–S14. doi:10.1016/j.jpeds.2008.05.005. PMCΒ 2810958. PMIDΒ 18639722.
  21. ↑ Kerem E, Reisman J, Corey M, Canny GJ, Levison H (1992). “Prediction of mortality in patients with cystic fibrosis”. N. Engl. J. Med. 326 (18): 1187–91. doi:10.1056/NEJM199204303261804. PMIDΒ 1285737.
  22. ↑ MUNROE DS, RALLY CR (1963). “The diagnosis of mitral stenosis”. Can Med Assoc J. 88: 611–22. PMCΒ 1921207. PMIDΒ 13936649.
  23. ↑ Chandrashekhar Y, Westaby S, Narula J (2009). “Mitral stenosis”. Lancet. 374 (9697): 1271–83. doi:10.1016/S0140-6736(09)60994-6. PMIDΒ 19747723.
  24. ↑ Brown LM, Chen H, Halpern S, Taichman D, McGoon MD, Farber HW, Frost AE, Liou TG, Turner M, Feldkircher K, Miller DP, Elliott CG (2011). “Delay in recognition of pulmonary arterial hypertension: factors identified from the REVEAL Registry”. Chest. 140 (1): 19–26. doi:10.1378/chest.10-1166. PMCΒ 3198486. PMIDΒ 21393391.
  25. ↑ Sun XG, Hansen JE, Oudiz RJ, Wasserman K (2003). “Pulmonary function in primary pulmonary hypertension”. J Am Coll Cardiol. 41 (6): 1028–35. PMIDΒ 12651053.
  26. ↑ Kahrilas PJ, Hughes N, Howden CW (2011). “Response of unexplained chest pain to proton pump inhibitor treatment in patients with and without objective evidence of gastro-oesophageal reflux disease”. Gut. 60 (11): 1473–8. doi:10.1136/gut.2011.241307. PMIDΒ 21508423.
  27. ↑ Badillo R, Francis D (2014). “Diagnosis and treatment of gastroesophageal reflux disease”. World J Gastrointest Pharmacol Ther. 5 (3): 105–12. doi:10.4292/wjgpt.v5.i3.105. PMCΒ 4133436. PMIDΒ 25133039.
  28. ↑ Boyce NW, Holdsworth SR (1986). “Pulmonary manifestations of the clinical syndrome of acute glomerulonephritis and lung hemorrhage”. Am. J. Kidney Dis. 8 (1): 31–6. PMIDΒ 3728460.
  29. ↑ Foster MH (2017). “Basement membranes and autoimmune diseases”. Matrix Biol. 57-58: 149–168. doi:10.1016/j.matbio.2016.07.008. PMCΒ 5290253. PMIDΒ 27496347.
  30. ↑ Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD, Rottem M, Fauci AS (1992). “Wegener granulomatosis: an analysis of 158 patients”. Ann. Intern. Med. 116 (6): 488–98. PMIDΒ 1739240.
  31. ↑ Falk RJ, Gross WL, Guillevin L, Hoffman GS, Jayne DR, Jennette JC, Kallenberg CG, Luqmani R, Mahr AD, Matteson EL, Merkel PA, Specks U, Watts RA (2011). “Granulomatosis with polyangiitis (Wegener’s): an alternative name for Wegener’s granulomatosis”. Arthritis Rheum. 63 (4): 863–4. doi:10.1002/art.30286. PMIDΒ 21374588.
  32. ↑ Carmona EM, Kalra S, Ryu JH (2016). “Pulmonary Sarcoidosis: Diagnosis and Treatment”. Mayo Clin. Proc. 91 (7): 946–54. doi:10.1016/j.mayocp.2016.03.004. PMIDΒ 27378039.
  33. ↑ Yanardağ H, Pamuk GE, Karayel T, Demirci S (2002). “Bone marrow involvement in sarcoidosis: an analysis of 50 bone marrow samples”. Haematologia (Budap). 32 (4): 419–25. PMIDΒ 12803116.
  34. ↑ Jennette, J. Charles; Falk, Ronald J. (1997). “Small-Vessel Vasculitis”. New England Journal of Medicine. 337 (21): 1512–1523. doi:10.1056/NEJM199711203372106. ISSNΒ 0028-4793.
  35. ↑ Vaglio A, Buzio C, Zwerina J (2013). “Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): state of the art”. Allergy. 68 (3): 261–73. doi:10.1111/all.12088. PMIDΒ 23330816.
  36. ↑ Lanham JG, Elkon KB, Pusey CD, Hughes GR (1984). “Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome”. Medicine (Baltimore). 63 (2): 65–81. PMIDΒ 6366453.

Editor-In-Chief:
C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karina Zavaleta, MD [2], Anmol Pitliya, M.B.B.S. M.D.[3]