Acute Cough

Differential Diagnosis

Upper Respiratory Tract

Lower Respiratory Tract


Any degree Resp. Distress — Must get CXR
The following guide is for well-appearing pts, normal resp. rate & O2Sat

Cough  —  NO Fever  and  NORMAL Lung Exam

Prominent Nasal Sx  —  Consider:
  • URI — default Dx (Sx <2 wks)
  • Allergic Rhinitis  —  any of below
    • Sneezing / Itchy Eyes
    • Prior Recurrent Episodes
    • PE:  Pale Mucosa, Allergic Shiners/Salute
  • Sinusitis (uncommon)
    • Initial Sx resolving, & suddenly worsen
No Nasal Sx
  • Tracheitis  (probably)
  • Pertussis  (consider)

Cough  PLUS  Fever

Influenza Season  (late Nov – April)

Day #1-3:  Dx Influenza.  No CXR unless:
  • Rales
  • Significant Dyspnea or Pleuritic CP
  • Compromised Host
Day #4-5 & later:  Get CXR (r/o Pneumonia) if:
  • Not beginning to get better
  • Getting better, then abruptly worse

Not Influenza Season

Same as above, except:
  • Dx Viral Syndrome
  • Lower threshold for CXR to r/o Pneumonia
    • Purulent Sputum without Nasal Sx
    • Very abrupt onset plus Pleuritic CP

Cough  PLUS Abnormal  Lung Sounds  (NO fever)

** Rales:  Get CXR
  • Bibasilar Rales suggest CHF
  • New Focal Rales:  See what’s there
** Wheezes = Bronchospasm
  • Dx Bronchitis if no prior Hx
  • Dx Asthma if Hx frequent prior episodes
  • Dx COPD Exacerbation if Hx suggestive of COPD
** Rhonchi:  same as for “Wheezes”
**  Prolonged Expiratory Phase:  same as for “Wheezes”

**  Stridor:  Think Tracheal Obstruction

Cough PLUS Convincing New  SOB (no fever, normal lungs)
  • Get CXR
  • Normal CXR: Tx for Bronchospasm

See postings Acute Cough – 1 and Acute Cough – 2.