The following symptoms and complaints may occur along with Cough:
Leading symptom
- Cough (lat. tussis; explosive expulsion of air, either voluntary or triggered by a coughing stimulus via the cough reflex).
Associated symptoms
- Sputum (sputum), ie productive cough (see also under “Sputum – Sputum”)Note: Sputum color has no predictive value for the diagnosis of bacterial bronchitis (inflammation of the mucous membrane of the bronchi), it also does not allow differentiation between pneumonia (pneumonia) and bronchitis.
- Foreign body sensation
- Dysphonia (hoarseness)
- General weakness
- Fever
- Bad breath (halitosis, foetor ex ore)
- Other accompanying symptoms depending on the cause of the disease (see, for example, with influenza infection with, for example, upper respiratory tract infection (URTI; common cold), acute bronchitis, pneumonia (pneumonia), pertussis (whooping cough); chronic respiratory diseases such as bronchial asthma, infektexacerbated chronic obstructive pulmonary disease, COPD).
Temporal occurrence of cough and their possible causes
| Modalities | Possible causes |
| Morning | Smoker’s cough, chronic bronchitis |
| Nighttime | Cardinal asthma (due to advanced left ventricular failure/left heart failure or mitral stenosis), bronchial asthma |
| During stress | Bronchial asthma, cardinal asthma, pulmonary fibrosis (group of chronic diseases associated with remodeling of the lung skeleton (interstitial lung diseases)) |
| In case of change of position | Bronchiectasis (synonym: bronchiectasis)-permanent 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 three-layered sputum: Froth, mucus, and pus), fatigue, weight loss, and decreased exercise capacity), lung abscess (encapsulated pus cavity in the lungs), foreign body aspiration (entry of foreign body into the airway) |
| After eating | Dysphagia (dysphagia), aspiration. |
Quantity and quality of sputum and their possible causes
| Modalities | Possible causes |
| Dry cough (irritating cough) | Expression of bronchial hyperresponsiveness (hypersensitivity of the airways (e.g., in asthma) in which the bronchi constrict abruptly) after viral infectionsBronchial asthma, influenza (flu), atypical pneumonia (lung inflammation), emphysema (pulmonary hyperinflation), pulmonary fibrosis, bronchial carcinoma, pleurisy (pleurisy), drug side effects |
| Large amounts of sputum (sputum) | Bronchiectasis (synonym: bronchiectasis), lung abscess, pneumonia |
| White sputum | Bronchial asthma (viscous), pulmonary edema (fluid), pertussis (whooping cough) |
| Purulent sputum(lat. pus) | Bronchitis (sputum color has no predictive value for the diagnosis of bacterial bronchitis, nor does it allow differentiation between pneumonia (lung inflammation) and bronchitis), bronchiectasis, lung abscess, pneumonia |
| Bloody sputum(lat. sanguis). | Acute bronchitis with injured mucosa, bronchial carcinoma/lung cancer (hemoptysis/bloody cough), pulmonary tuberculosis (initially nonproductive, later with sputum with blood admixtures), injury or foreign body |
| Damp cough and purulent inflammation of the respiratory tract. | Protracted bacterial bronchitis (PBB)Chronic suppurative airway/lung disease (CSLD)Bronchiectasis. |
Warning signs (red flags)
- Anamnestic information:
- Residence in countries with high TB prevalence, TB contacts, homeless.
- Infant
- Cough from birth
- Failure to thrive
- Drinking difficulty and conspicuousness
- Infant
- Failure to thrive
- Daily moist mucous cough → think of:
- Protracted bacterial bronchitis (PBB); possible germs: Haemophilus influenza, Streptococcus pneumoniae, Moraxella catarrhalis; often confused with bronchial asthma.
- Serious underlying disease or chronic infection (eg.B. Tuberculosis, Pseudomonas aeruginosa infection (in cystic fibrosis, CF).
- Aspiration (entry of material from the gastrointestinal tract into the respiratory tract) or other sudden event
- Cough and recurrent dyspnea (recurrent shortness of breath) → think of: Bronchial asthma
- Duration of cough
- 4 weeks of persistent inflammation of the lower respiratory tract + main symptom “moist cough” → think of: Protracted bacterial bronchitis (PBB).
- > 8 weeks → think of: COPD, tuberculosis, bronchial carcinoma (lung cancer).
- Influenza, Streptococcus pneumoniae, Moraxella catarrhalis; often confused with bronchial asthma.
- Smokers (> 35 pack-years) → think of: chronic obstructive pulmonary disease (COPD), bronchial carcinoma (lung cancer).
- Abnormal weight loss → think of: Bronchial carcinoma (lung cancer), tuberculosis.
- Immunodeficiency, HIV infection, immunosuppressive therapy.
- Recurrent (recurrent) rhinosinusitis (simultaneous inflammation of the nasal mucosa (“rhinitis”) and the mucosa of the paranasal sinuses (“sinusitis“)).
- Malignancy (cancer)
- Altered vital signs (high fever: 39.1 °C – 39.9 °C; possibly also already 38.5 °C; tachycardia: too fast heartbeat: > 100 beats per minute).
- New onset cough + dyspnea + fever → pneumonia (until proven otherwise).
- Acute heart failure (cardiac insufficiency).
- Acute intoxication (poisoning) by inhaled noxious agents.
- Dysphonia (hoarseness) + dyspnea (shortness of breath) → think of: Laryngeal carcinoma (cancer of the larynx).
- Dyspnea (shortness of breath) – insb. resting dyspnea.
- Hemoptysis (hemoptysis) → see under “Causes” of hemoptysis; e.g. pulmonary embolism (occlusion of a pulmonary artery), cavities (cavities formed by liquefaction of larger necrosis lesions; pathological change in lung tissue that can occur in the context of tuberculosis), lung tumors.
- Tachypnea → think of:
- Left ventricular failure (left-sided heart failure).
- Pulmonary edema (water retention in the lungs)
- Pneumonia (pneumonia)
- Pneumothorax (collapse of the lung caused by an accumulation of air between the visceral pleura (lung pleura) and the parietal pleura (chest pleura)).
- Thoracic pain → think of:
- Bronchitis (inflammation of the bronchi).
- Pulmonary embolism
- Tuberculosis
- Continuous medication: immunosuppressants (drugs that reduce the functions of the immune system).
In the presence of the above warning signs, a chest X-ray and pulmonary function test is required immediately, regardless of the duration of the cough! Exception: infant with daily moist mucus cough, here for the time being only examination of sputum and pulmonary function testing.
