Cough is one of the most common symptoms seen in both outpatient and emergency settings. While most cases are mild and self-limited, some are signs of serious or life-threatening disease such as pneumonia, TB, or respiratory distress.
Your uploaded chart divides cough into:
- Red Flags
- Acute causes
- Chronic causes
- Special considerations (HIV, TB, ACE-inhibitors)
- Documentation essentials
This article builds on that structure in a clear, academic, clinical style.
Red Flags in Cough
Any cough accompanied by the following symptoms should raise concern for serious conditions:
Red Flags
- Respiratory distress
- Fever with productive sputum
- Hemoptysis (coughing blood)
- HIV or immunocompromised state
- Weight loss
- TB risk factors (travel, jail, shelters, exposure)
- ACE-inhibitor use
- Persistent cough > 3–8 weeks
Red flags push the differential toward pneumonia, TB, asthma exacerbation, CHF, malignancy, or opportunistic infections.
Acute Causes of Cough
(based on the chart’s “Acute” section)
A. Allergic Rhinitis
History/Exam Clues:
- Seasonal symptoms
- Swollen, itchy eyes
- Nasal congestion
Workup:
- ClinicalTreatment:
- Antihistamines (e.g., loratadine)
- Avoid known allergens
B. Asthma / COPD
History/Exam Clues:
- Wheezing
- Tobacco use
- Shortness of breath
Workup:
- Clinical
- Chest X-ray if needed (see SOB workup)
Treatment:
- Nebulizers
- Steroids
- COPD may need antibiotics
C. Pneumonia
History/Exam Clues:
- Fever
- Productive sputum
- Dyspnea
- Chest discomfort
Workup:
- Clinical
- Chest X-ray
Treatment:
- Antibiotics
- Hydration
- Follow pneumonia guidelines
(Reference: “See SOB, p. 16” from your chart)
D. Sinusitis
History/Exam Clues:
- Purulent rhinorrhea
- Facial pressure
- Tenderness over sinuses
Workup:
- ClinicalTreatment:
- Nasal spray
- Pseudoephedrine
- ± Antibiotics (if bacterial)
E. Tuberculosis (TB)
History/Exam Clues:
- Night sweats
- Hemoptysis
- Weight loss
- Travel, jail, homeless shelter exposure
- Slow, insidious onset
Workup:
- Isolation
- Chest X-ray
Treatment:
- TB antibiotics
- Admit to isolation
F. URI (Upper Respiratory Infection)
History/Exam Clues:
- Congestion
- Rhinorrhea
- Aches
Workup:
- ClinicalTreatment:
- Reassurance
- Zinc?
- Fluids and rest
Chronic Causes of Cough
A. ACE-Inhibitor–Induced Cough
History/Exam Clues:
- On ACE-inhibitors
- Dry cough
- No signs of infection
Workup:
- Clinical (look for ARB as substitute)Treatment:
- Stop ACE-inhibitor
- Switch medication
(This cause is rare with ARBs, per chart.)
B. GERD (Gastroesophageal Reflux Disease)
History/Exam Clues:
- Triggered after meals
- Epigastric discomfort
- Nighttime cough
Workup:
- ClinicalTreatment:
- GI cocktail
- Lifestyle modifications
- PPIs or antacids
Cough in Immunocompromised Patients
Your chart highlights a key note:
“HIV/Immunocompromised? → Broaden differential (PCP, TB)”
In such patients, consider:
- Pneumocystis pneumonia (PCP)
- Tuberculosis
- Atypical pneumonias
- Fungal infections
Workup includes:
- CXR
- Sputum cultures
- LDH (PCP marker)
- CD4 count
- HIV viral load
Summary Table
| Condition | Key Clues | Workup | Treatment |
|---|---|---|---|
| Allergic Rhinitis | Seasonal, swollen eyes | Clinical | Antihistamines |
| Asthma/COPD | Wheeze, tobacco | Clinical, CXR | Nebs, steroids, ± ABx |
| Pneumonia | Fever, sputum | CXR | Antibiotics |
| Sinusitis | Purulent discharge | Clinical | Nasal spray, ± ABx |
| TB | Night sweats, hemoptysis | Isolation, CXR | TB ABx, isolation |
| URI | Congestion | Clinical | Reassurance |
| ACE-Inhibitor | Dry cough | Clinical | Stop ACE-I |
| GERD | Epigastric pain | Clinical | GI cocktail |
Documentation Essentials
(from the bottom of your chart)
General
- Duration (days/weeks)
- No new meds/ACE-inhibitors
- Presence of sputum and fever
- No asthma/COPD/CHF history
- Sick contacts or recent travel
- TB risk factors
HEENT
- Nasal congestion
- Oropharynx non-erythematous
Lung Exam
- Clear lungs bilaterally
- No wheezing
- No rhonchi or crackles
Good documentation helps differentiate pneumonia, bronchitis, COPD flare, or viral illness.
High-Yield Clinical Pearls
- Hemoptysis ALWAYS requires evaluation → TB, pneumonia, or malignancy
- ACE-inhibitor cough occurs weeks to months after starting therapy
- Asthma/COPD + fever often means bacterial infection
- In HIV patients, always think PCP or TB
- Night sweats + weight loss → TB until proven otherwise
- A clear chest exam does NOT fully exclude pneumonia in early phases
- Purulent nasal discharge alone is not enough to diagnose sinusitis
FAQs About Cough
1. When is a cough serious?
When accompanied by fever, dyspnea, hemoptysis, or red flags.
2. How long does viral cough last?
Typically 7–14 days; residual cough may continue for weeks.
3. What is the most common cause of chronic cough?
Post-nasal drip, GERD, or ACE-inhibitors.
4. Does productive cough always mean bacterial infection?
No—viral infections can also produce sputum.
5. When should a patient with cough get a chest X-ray?
If they have fever, abnormal lung sounds, shortness of breath, hypoxia, or TB risk factors.
6. What is the danger of ignoring TB symptoms?
Delayed treatment leads to transmission and severe lung damage.
