Productive cough

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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]

Productive 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 Croup[1] Acute
  • 3−5 days
+ + +
  • Clinical diagnosis.
  • Laboratory findings and imaging are not necessary for diagnosis
Pertussis[2][3] Acute
  • Two weeks
+ Whooping sound + + +
  • Clear chest
  • Normal function
  • Culture
Laryngopharyngeal reflux[4][5] Chronic
  • Variable
+ +
  • Normal function
  • 24 hour−dual sensor pH probe
Common Cold[6] Acute
  • 3−10 days
+ +
  • Bacterial culture is not indicated
  • Normal function
  • Clinical diagnosis
Rhinosinusitis[7][8] Acute, subacute, chronic, recurrent
  • Acute: Less than 4 weeks
  • Subacute: 4−12 weeks
  • Chronic: More than 12 weeks
  • Recurrent: 4 or more episodes or acute rhinosinusitis per year
+ + +
  • Clear chest
  • Air−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[9] Chronic
  • Years
+ Clear mucoid or yellow sputum +
  • Family history
  • Seasonal variation
Acute Bronchitis[10] Acute
  • From 5 days to 1 or 3 weeks
+ +/− +
  • FEV1 < 80%
  • Clinical diagnosis
Chronic Bronchitis[11][12] Chronic
  • Most of the days for three months in the las two years.
+ Clear sputum + +
Non−asthmatic eosinophilic bronchitis[13][14] Chronic
  • More than 8 weeks
+ Eosinophilic sputum +
  • Exposure to an occupational cause
Bronchiectasis[15] Chronic
  • Months to years
+ Mucopurulent sputum + +
  • CT of chest
Emphysema [16] Chronic
  • Months to years
+ Mucoid or purulent sputum + +
  • Exposure of tobacco and air pollution
Foreing body aspiration[17][18][19] Acute
  • Variable
+ + + +
  • No specific tests
  • Not specific
  • In children <1 year and adults >75 years
  • Organic materials in children
  • Inorganic materials in adults
Bronchiolitis[20][21] Acute
  • 8−15 days
+ + +
  • Clinical 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 Parenchyma Pneumonia[22][23] Acute
  • Variable
+ Mucopurulent sputum + +
  • Not specific
Lung cancer[24][25] Chronic
  • Years
+ + + +/− + The following investigations may be helpful:
  • Not specific
Tuberculosis (TB)[26][27] Chronic
  • More than 2 or 3 weeks
+ + + + +
Cystic fibrosis (CF)[28][29] Chronic
  • Variable
+ + +/− +
  • 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
Cardiac Cardiogenic pulmonary edema[30][31] Acute
  • Days to weeks
+ Pink frothy, liquid + + The following investigations may be helpful:
  • Not specific
  • Clinical diagnosis
  • Tests are supportive
Mitral Stenosis[32][33] Chronic
  • Variable
+ Pink frothy + +
  • Not specifc
Gastrointestinal Gastroesophageal reflux[34][35] Chronic
  • Variable
+ + +
  • Not specific
  • Normal function
  • PH testing
−−
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 Wegener's disease (GPA) [36][37] Chronic
  • Months
+ + + + + The following investigations may be helpful:
Microscopic polyangitis (MPA)[38] Chronic
  • Variable
+ + + + + The following investigations may be helpful:
Churg−Strauss[39][40] Chronic
  • Variable
+ + + + +
  • Infiltrates in chest X−Ray
  • Ground glass opacities, tree−in−bud sign and small nodules in chest CT

References

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