In the case of only short-term cough (up to 8 weeks) in the context of acute inflammation of the upper respiratory tract, laboratory diagnostics are usually not necessary. If special circumstances are present that are not typical of an acute trivial respiratory tract infection, diagnostics for acute cough should be initiated immediately. See Cough/Symptomatic Complaints/Red flags. Mandatory medical device diagnostics (children only).
- Measurement of respiratory rate and, if necessary, oxygen saturation (SpO2).
- X-ray of the thorax (X-ray thorax/chest) – in children with chronic cough.
- Spirometry (basic examination as part of pulmonary function diagnostics) – in children with chronic cough.
Optional medical device diagnostics – depending on the results of the history, physical examination and mandatory laboratory parameters – for differential diagnostic clarification.
- X-ray of the chest (X-ray thorax/chest), in two planes – if pneumonia (pneumonia), structural lung disease, chronic cough (duration > 8 weeks and unclear cause of cough) or presence of warning signs (see below “Symptoms – complaints”) is suspected[Warning signs (red flags): abnormalities beyond peribronchial drawing proliferation].
- Thoracic sonography – imaging of intrathoracic organs / organs located outside the thoracic cavity (excl. the heart) by ultrasound; here: specifically used lung sonography, e.g., where auscultatorily a happening is suspected [compressions of the interstitium?, pleural fluid (detectability from volumes 5-10 ml; number and extent of air-containing bronchi? (increase in the course of healing)]
- Spirometry (basic examination as part of pulmonary function diagnostics) – if chronic obstructive pulmonary disease (COPD) is suspected, chronic cough (duration > 8 weeks) or presence of warning signs (see below “Symptoms – complaints”).
- Peak flow measurement – measurement of airflow, more specifically the respiratory flow rate, in a forced strong expiration (exhalation) – if bronchial asthma is suspected.
- Methacholine test (methacholine provocation test, English Methacholine Challenge Test) – nonspecific, inhalation provocation test to measure bronchial obstruction (constriction (obstruction) of the bronchi) and hyperreactivity (excessively strong (“exaggerated”) reaction to a stimulus), for example, in bronchial asthma.
- Computed tomography of the sinuses (sinus CT) – if chronic sinusitis (sinusitis) is suspected.
- Computed tomography of the thorax / chest (thoracic CT) – if tumors are suspected.
- Magnetic resonance imaging of the thorax / chest (thoracic MRI) – if tumors are suspected.
- Gastroscopy (gastroscopy) – for suspected gastroesophageal reflux disease (synonyms: GERD, gastroesophageal reflux disease; gastroesophageal reflux disease (GERD); gastroesophageal reflux disease (reflux disease); gastroesophageal reflux; reflux esophagitis; reflux disease; Reflux esophagitis; peptic esophagitis); inflammatory disease of the esophagus (esophagitis) caused by the pathological reflux (reflux) of acid gastric juice and other gastric contents.
- Electrocardiogram (ECG; recording of the electrical activity of the heart muscle) – if heart failure (cardiac insufficiency) is suspected.
- Echocardiography (echo; heart ultrasound) – if heart failure or pulmonary embolism is suspected.
- Bronchoscopy (pulmonary endoscopy), if necessary with biopsy (tissue sampling) – on suspicion of anatomical abnormalities, foreign bodies, malacia, mucus impaction, stenosis; is considered the gold standard for the diagnosis of pathological changes of the bronchial tract.
Stage diagnostics:
- X-ray chest/thorax and pulmonary function testing; if chest x-ray and pulmonary function normal: 2nd step; nonspecific bronchial provocation.
- Methacholine test (methacholine provocation test, English methacholine challenge test).
- Computed tomography (CT) or bronchoscopy (lung endoscopy); at the end of the diagnosis is always indicated bronchoscopy!
Further notes
- In infants and young children with chronic cough (duration > 8 weeks) generous referral to a specialized center to offer the patient the widest possible range of diagnostic and therapeutic options.
