Cough

Question 1

Timeframe

Answer 1

Onset- when did you first notice the cough
Progression- has it changed recently
Timing- is it there all the time/ worse at any point in the day/ vary with seasons or weather
Triggers- does anything set it off

Question 2

Relevant systems review

Answer 2

FWAR

Cardiorespiratory- sputum (normal for you), haemoptysis, chest pain (if yes do SOCRATES), palpitations, SOB (quantify exercise tolerance), wheeze, leg swelling

GI- do you suffer from heart burn (can irritate the vocal cords)

Anyone else in the house unwell?

Question 3

Pneumonia

Answer 3

Acute productive cough
Associated sob/ pleuritic chest pain/ haemoptysis/ wheeze
Systemic Sx eg. Fever
Often a background of respiratory disease (COPD/ bronchiectasis)

NB- consider whether it could be the first presentation of HIV eg. PJP

Question 4

Asthma

Answer 4

Nocturnal cough 
Intermittent wheeze
SOB
Diurnal variation 
Exacerbating factors
Background of atopy eg. Eczema or hay fever

Question 5

Post nasal drip

Answer 5

Chronic sinusitis
Short history of a cough with a recent URTI but otherwise well
Runny nose, congestion, sore throat, sinusitis and throat clearing

Question 6

COPD

Answer 6

Chronic productive cough and wheeze
Chronic SOB (usually within a week of starting therapy)
Progressive disability
Significant smoking history

Question 7

Others

Answer 7

GORD
ACE inhibitor
IPF
Bronchiectasis

Question 8

Lung tumour

Answer 8

Haemoptysis
Weight loss
Signifcant smoking history
Paraneoplastic syndromes (small cell lung cancer)
Recurrent chest infections/ chest discomfort

Question 9

Occupation/ lifestyle

Answer 9

Exposure to asbestos or other chemicals

Do you or anybody that you live with smoke

Question 10

GORD

Answer 10

Overweight person with retrosternal burning pain worse on lying flat
Acid brash, with regurgitation of sour material after eating a large meal
Hoarse voice and periodic clearing of throat

Question 11

Bronchiectasis

Answer 11

Precipitated by recurrent infections or a particularly bad infection
Produce a large amount of sputum per day (cup fills)
Haemoptysis or brethlessness may be seen
CF associated with bronchiectasis

Question 12

COVID19

Answer 12

COVID is now a differential for anyone who presents with a cough
Ask about vaccines, loss of sense of taste and smell
May see COVID pneumonitis on an XRay

Question 13

Patients perspective

Answer 13

How has it affected you
Ideas
Concerns
Expectations

Question 14

PMH

Answer 14

Asthma COPD

Question 15

Medications

Answer 15

Allergies

Ace inhibitors

Question 16

FH

Answer 16

Asthma

Question 17

SH

Answer 17

Any recent travel (6 months)
Smoke alcohol recreational drugs
Working- exposure to irritants eg. Asbestos (past)
Pets
Home situation (overcrowding- TB)
If going nowhere- could do a sexual history to rule in/out HIV

Question 18

ACE inhibitors

Answer 18

No other symptoms
Just a dry cough
Usually a week within starting therapy but can be up to 6 months

Question 19

Investigations

Answer 19

Full cardiorespiratory exam 
FBC UE LFT blood culture 
Sputum culture 
CXR 
Peak flow pulmonary function tests 
CT thorax or bronchoscopy may be needed