Cough: Or something else? Differential Diagnosis

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

  • Kartagener syndrome – congenital disorder; triad of situs inversus viscerum (mirror-image arrangement of organs), bronchiectasis (synonyms: bronchiectasis; dilatation of bronchi), and aplasia (nonformation) of paranasal sinuses; disorders without situs inversus are called primary ciliary dyskinesia (Engl. Primary Ciliary Dyskinesia, PCD): congenital disorder of the respiratory tract in which the movement of the cilia is disturbed; the disorder is associated with recurrent respiratory tract infections. [Infantile]
  • Laryngeal cleft (defect of the upper airway in terms of a cleft communication between esophagus/esophagus and larynx/larynx) [infancy].
  • Cleft lip and palate (LKGS clefts) [infancy].
  • Tracheoesophageal fistula (fistula between the trachea (windpipe) and esophagus (esophagus)) [infancy]

Respiratory System (J00-J99)

  • Acute bronchitis 1
  • Bronchial asthma 2 [onset usually in adolescence]
  • Bronchial hyperresponsiveness 1 (chronic, inflammatory disease of the airways with persistent hypersensitivity; typically after exertion and exposure to cold air) [esp. childhood]
  • Bronchiectasis (synonym: bronchiectasis) 2 – persistent irreversible saccular or cylindrical dilatation of the bronchi (medium-sized airways) that may be congenital or acquired; symptoms: chronic cough with “mouthful expectoration” (large-volume triple-layered sputum: foam, mucus, and pus), fatigue, weight loss, and decreased exercise capacity
  • Bronchocentric granulomatosis – necrotizing granulomatosis of the lung in the area of the small bronchi and bronchioles.
  • Influenza (“common cold”) 1
  • Chronic bronchitis 2
  • Chronic obstructive pulmonary disease (COPD) (acute exacerbation/exacerbation of symptoms, if any) 2 [adult].
  • Exacerbation of chronic bronchitis – acute exacerbation of chronic bronchitis.
  • Exogenous allergic alveolitis (hypersensitivity pneumonitis) – farmer’s lung, bird breeder’s lung, etc.
  • Upper respiratory tract infection (URTI) 1.
  • Upper and lower respiratory tract infections, unspecified.
  • Pulmonary fibrosis – pulmonary diseases associated with the proliferation of connective tissue fibers (fibrosis).
  • Pulmonary edema – edema (water accumulation) in the lungs [symptoms: tachypnea (respiratory rate > 20/min), dyspnea (shortness of breath), exacerbated breath sounds, moist RGs/rales].
  • Papillomatosis – occurrence of multiple benign neoplasms, mostly in the respiratory tract.
  • Pleurisy (pleurisy):
    • Leading symptoms of pleurisy sicca (dry course): respiratory pain, irritable cough (without sputum).
    • Leading symptoms of pleuritis exsudativa (wet course): dyspnea (shortness of breath) (depending on the size of the pleural effusion) and occasionally fever.
  • Pneumothorax 1 – collapse of the lung caused by an accumulation of air between the visceral pleura (lung pleura) and the pleura parietalis (pleura); clinical picture: dyspnea (shortness of breath), dry cough and stabbing pain in the thorax (chest), may also radiate to the abdomen (abdominal cavity) and / or shoulder; later, when stable pneumothorax only dull pressure.
  • Pseudocroup (laryngitis subglottica) – laryngitis (laryngitis), which leads mainly to swelling of the mucosa below the vocal cords [infancy, childhood].
  • Pneumonia 1 (pneumonia)
  • Protracted bacterial bronchitis (PBB) 2 – more common form of differential diagnosis of chronic cough v. a. in otherwise (lung) healthy children < 6 years; clinical picture: moist cough ≥ 4 weeks, ≥ 104 CFU/ml (Engl.”Monoinfection of the lower respiratory tract detected in bronchoalveolar lavage (BAL; method for obtaining samples used in bronchoscopy) or in sputum (sputum); causes: primary tracheomalacia (disease characterized by slackening of the trachea) or consequence of mechanically stressful cough; complication: Unrecognized, PBB often progresses to chronic suppurative lung disease; Therapy: under a 2-week empiric antibiotic cycle (usually amoxicillin–clavulanic acid), cough typically improves [ages range from 10 to 60 months]Note: Relapse rate is very high in children with PBB despite prolonged antibiotic administration.
  • Reactive Airway Dysfunction Syndrome (RADS): asthma-like attacks with cough after exposure to gases or other chemical irritants,; often considered occupational asthma (“irritant asthma”)
  • Rhinitis (“common cold“).
  • Rhinosinusitis 2 – (simultaneous inflammation of the mucous membrane of the nose (“rhinitis”) and the mucous membrane of the paranasal sinuses (“sinusitis“).
  • Sinusitis (sinusitis) → sinubronchitis.
  • Vocal cord dysfunction (Engl. Vocal Cord Dysfunction, VCD) – leading symptom of VCD: Abruptly occurring, dyspnea-inducing laryngeal obstruction (laryngeal constriction usually experienced in the cervical or upper tracheal region), usually during inspiration (inhalation), which can lead to dyspnea of varying intensity, inspiratory stridor (breath sounds on inhalation), no bronchial hyperresponsiveness (airway hypersensitivity in which the bronchi abruptly constrict), normal lung function; cause: Paradoxical intermittent glottis closure; especially in younger women.
  • Tracheitis (inflammation of the trachea).
  • Tracheobronchitis 1 (inflammation of the tracheal and bronchial mucosa) [infancy, childhood].
  • Upper-airway-cough syndrome 2 (UARS; formerly: postnasal drip syndrome, (PNDS), sinubronchial syndrome) – symptoms: chronic cough, throat irritation, overproduction of mucus on the nasal mucosa or in the paranasal sinuses, which leads to accumulation of secretions in the throat area
  • Subtype of sleep-related breathing disorders (SBAS); symptoms: snoring, daytime sleepiness, affective disturbances, difficulty falling asleep, and respiratory flow limitations associated with arousal during sleep [adult].

Blood, blood-forming organs – immune system (D50-D90).

  • Sarcoidosis – inflammatory multisystem disease, the cause of which is still unclear.

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Cystic fibrosis (ZF) 2 – genetic disease with autosomal recessive inheritance characterized by the production of secretions in various organs that need to be tamed. [early infancy; in up to 20% within the first 24 hours of life.]

Cardiovascular System (I00-I99).

Infectious and parasitic diseases (A00-B99).

  • Allergic bronchopulmonary aspergillosis (ABPA) – mixed allergic disease of the lung (type I and type III allergy) triggered by molds of the tubular fungus genus Aspergillus.
  • Infectious diseases, unspecified
  • Influenza 1
  • Morbilli (measles) [dry irritating cough].
  • Pertussis 1 [whooping cough, vomiting/mucus vomiting] [children].
  • Tuberculosis 2 [consumption].

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

  • Gastroesophageal reflux disease 2 (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 of acidic gastric juice and other gastric contents – symptoms are particularly severe when lying down and after eating [classic, esophageal symptoms (heartburn, belching); 75% of cases no typical symptoms! Irritation of the throat, hoarseness, cough, “asthma”]
  • Laryngopharyngeal reflux (LRP) – “silent reflux” in which the cardinal symptoms of gastroesophageal reflux, such as heartburn and regurgitation (backflow of food pulp from the esophagus into the mouth), are absent.

Neoplasms – tumor diseases (C00-D48).

  • Bronchial carcinoma (lung cancer) (cough as signum mali ominis (bad sign in terms of prognosis); other symptoms: Dyspnea (shortness of breath), weight loss, or hemoptysis (coughing up blood)).
  • Laryngeal carcinoma (cancer of the larynx).

Psyche – nervous system (F00-F99; G00-G99)

  • Habitual cough 2 – diagnosis can be made if at least 1 + 2 + 5 are present:
    1. Sound character: tracheal, barking, roaring, loud (individual stereotypy)).
    2. Frequency: long-term existing, very variable frequent occurrence during the day (a few times to incessant).
    3. Duration: at least 4 weeks
    4. No coughing at night
    5. Failure to respond to adequate pharmacotherapy.
    6. If necessary, also distractibility
  • Psychogenic cough (synonyms: somatic cough disorder, tic-cough; common in children six to 16 years of age; approximately 3-10% of children (> 1 Mt) with chronic cough) – compulsion to cough or clear throat.

Symptoms and abnormal clinical and laboratory findings not classified elsewhere (R00-R99).

  • Chronic idiopathic cough (CIC, chronic idiopathic cough)/cough of unexplained cause: despite a differentiated diagnostic approach and specific therapeutic measures, the etiology of chronic cough remains unexplained in up to 20% of cough patients, i.e., no cause or trigger is found. A hypersensitivity of the cough receptors is discussed as the cause. Subliminal stimuli in CIC are: prolonged speech, smoke inhalation, cold air, dry air and perfume odor.Interdisciplinary therapy approaches (including physiotherapy, speech therapy, psychotherapy) can be helpful.
  • Dysphonia (hoarseness), functional (often women in professions with heavy voice use; nonspecific symptoms: scratching, throat clearing, coughing; swallowing compulsion, globus; mucus sensation).
  • Cough of unexplained cause:
  • Cardiomegaly – enlargement of the heart beyond normal.
  • Xerostomia (dry mouth)

Causes (external) of morbidity and mortality (V01-Y84).

  • Foreign body aspiration 2 (inhalation of foreign bodies); symptoms: inspiratory stridor (breathing sound during inhalation (inspiration); esp. in children/especially seeds and peanuts) – sudden onset; note: an interdisciplinary approach is always required when removing foreign bodies from the airways of children!

Factors affecting health status leading to health care utilization (Z00-Z99).

  • Allergies 2 to unspecified antigens (e.g., chemicals, wood dust, intramural fungi, flour dust, food, plant dust (pollen), animal dander, etc.).

Medication

  • ACE inhibitors 2 (benazepril, captopril, cilazapril, enalapril, fosinopril, imidapril, lisinopril, moexipril, perindopril, quinapril, ramipril, spirapril, trandolapril, zofenopril) [irritable cough; dry cough; not dose-related; occurrence within hours to weeks/months]
  • Amiodarone (antiarrhythmic agent).
  • Analgesics
    • Coxiebe (celecoxib, parecoxib)
  • Angiotension II receptor antagonists (AT-II-RB; ARB; angiotensin II receptor subtype 1 antagonists; angiotensin receptor blockers; AT1 receptor antagonists, AT1 receptor blockers, AT1 antagonists, AT1 blockers; Angiotensin receptor blockers, sartans) – candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan [Side effect: Irritable cough is questionable according to current studies]
  • Anticholinergics (ipratropium bromide).
  • Beta blockers
  • Cromoglicic acid
  • mTOR inhibitors (everolimus, temsirolimus).
  • N-methyl-D-aspartate recptor antagonist (memantine).
  • Cytostatics
    • Antimetabolites (methotrexate (MTX))

Environmental pollution – intoxications (poisonings).

  • Inhaled noxious agents 1 (particulate matter, smoke).

Further

  • Foreign body (hair after haircut; cerumen (earwax)) in the external auditory canal → reflex cough (reflex cough) [children].
  • Foreign body cough [children]
  • Smoking

Legend

  • In bold the most common diseases
  • 1Most common causes of acute cough.
  • 2Frequent causes of chronic cough.