Cough overview

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Cough Microchapters


Patient Information



Historical perspective



Differentiating Cough from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis


Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings


Chest X Ray



Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies


Medical Therapy


Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], M.Umer Tariq [3] Abiodun Akanmode,M.D.[4]


A cough is a sudden, often repetitive, spasmodic contraction of the thoracic cavity, resulting in a violent release of air from the lungs, and usually accompanied by a distinctive sound. A cough by itself is not a complete diagnosis but rather a symptom of an underlying condition, despite this, it accounts for one of the most common indications for visits to the general practitioners and family physicians with a good proportion of these cases resulting in a pulmonology referral.

Coughing is an action the body takes to get rid of substances that are irritating the air passages. The act of coughing can be triggered by a myriad of conditions physiologic and otherwise, A cough is mostly initiated to clear a buildup of phlegm within the trachea. Coughing can also be triggered by a bolus of food entering the trachea and other parts of the respiratory tree rather than the esophagus due to a failure of the epiglottis. During the management of cough the duration is an important tool utilized by the clinicians; and when presented with a history of frequent or chronic coughing the presence of an underlying disease should be suspected. In non-smoking patients with a normal chest X-ray, chronic cough in 93% of these patients' cohort can be attributed to asthma, heartburn or post-nasal drip. Other causes of chronic cough include chronic bronchitis and medications such as ACE inhibitors. Coughing can happen voluntarily as well as involuntarily.

The uncleanness of most cases of cough with regard to etiology, duration, and other precipitating symptoms coupled with the lack of a universal guideline for quantifying cough results in variability during its assessment. Thus, a thorough evaluation should be done to isolate the etiology of the patient's cough when they present, and before initiating therapy for symptomatic relief.


The accepted classification of cough is that of the ACCP(American college of chest physicians).Cough is classified into 3 types depending on its duration.


The act of coughing is a vital one that leads to the mucociliary clearance of excess secretions from the airway and other parts of the respiratory tree.Cough occurs via a complex neurophysiologic cough reflex arc.


There are various causes of cough,the most common causes are:

Cough causes can also be classified according to the organ system, see the segment on cough causes for details.

Differentiating Cough from other Diseases

Making a differential diagnosis when a patient presents with a cough can be challenging however when the clinician asks about the other associated symptoms such as fever, vomiting, night sweats, weight loss, sputum production, and quantity, smoking history, drug use and most importantly the duration of the cough, making a differential diagnosis becomes less challenging.See the segment on Cough differential diagnosis for an extensive overview of the various differential diagnosis of cough.

Cough Risk Factors

Cough is a protective reflex, however, some factors can increase one's risk of having a cough.

Cough natural history, complications, and prognosis

The various complications associated with cough can be categorized according to systems involved also, Cough complications can also be acute or chronic. See the segment on Cough natural history, complications, and prognosis.

Cough diagnostic study of choice

There is no single diagnostic study of choice for the diagnosis of cough.

History & Symptoms

A detailed cough history should cover the following:

  • Onset of symptoms.
  • Dry vs Productive cough.If productive, sputum content, color, amount, etc.
  • Duration.
  • Exacerbating/relieving factors.
  • Previous episodes.
  • Frequency.
  • Drug use eg:ACEIs

Other associated cough symptoms includes

Physical examination

Once an in-depth history is taken from the patient, a detailed physical examination consisting of inspection, palpation, percussion, and auscultation should be done when evaluating coughing patients.

Cough laboratory findings

Some laboratory test used when evaluating cough are:

Chest x ray

Chest X-rays are a go-to investigative tool used by most clinicians when evaluating cough. Despite the routine use of CXR when evaluating cough, the most common causes of cough in the general population such as Gerd, Asthma and Post nasal drip cannot readily be diagnosed by CXR.


The use of a high resolution CT may identify pulmonary parenchymal lesions/diseases that were not readily picked up by CXR in patients with chronic cough.


The use of MRI in the diagnosis of cough is particularly useful when red flags are noted during the detailed medical history and physical examination of the patient.

Other imaging studies


Treatment of cough depends on its etiology. Cough treatment is mostly medical with the use of cough syrups, antibiotics, modifying lifestyle, etc. The use of surgery limited to few cases refractory to medical therapy. See the chapter on Cough medical therapy and Cough surgery for a detailed algorithm on cough treatment.

Cough primary prevention

Avoiding smoking, areas with air pollution, and proper hand hygienic practices can prevent one from acquiring cough due to other causes.

Cough secondary prevention

There are no established guidelines for the secondary prevention of cough.


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