Some Causes and Features of Cough in Adults
Cause | Common Features* | Tests |
|---|---|---|
Acute (lasting less than 8 weeks) | ||
A chronic obstructive pulmonary disease (COPD) flare-up | Wheezing, shortness of breath, and breathing through pursed lips Cough often produces sputum In people who already have COPD | Usually only a doctor's examination |
A foreign object† | A cough that begins suddenly typically in people who have a disorder that interferes with communication, swallowing, or both, or in children No symptoms of an upper respiratory infection In people who otherwise are feeling well | A chest x-ray |
Shortness of breath that worsens while lying flat or that appears 1–2 hours after falling asleep Usually sounds suggesting fluid in the lungs, heard through a stethoscope Usually swelling (edema) in the legs | A chest x-ray Sometimes a blood test to measure a substance called brain natriuretic peptide (BNP) that is produced when the heart is strained Sometimes echocardiography | |
Fever, a feeling of illness, a cough that produces sputum (productive cough), and shortness of breath Sudden onset of sharp chest pain that worsens when taking deep breaths Certain abnormal breath sounds, heard through a stethoscope | A chest x-ray | |
Postnasal drip (due to an allergy, a virus, or bacteria) | Headache, sore throat, and a congested nose with pale, swollen mucosa Nausea Sometimes a drip visible at the back of the throat Frequent clearing of the throat | Usually only a doctor's examination |
Pulmonary embolism† (sudden blockage of an artery in a lung, usually by a blood clot) | Sudden appearance of sharp chest pain that usually worsens when inhaling Shortness of breath A rapid heart rate and a rapid breathing rate Often risk factors for pulmonary embolism, such as cancer, immobility (as results from being bedbound), blood clots in the legs, pregnancy, use of birth control pills (oral contraceptives) or other medications that contain estrogen, recent surgery or hospitalization, or a family history of the disorder | Specialized lung imaging tests, such as CT angiography, ventilation-perfusion (V/Q) scanning, or pulmonary arteriography |
Upper respiratory infections, including acute bronchitis | A runny, congested nose with red mucosa (the tissues that line the nose) Sore throat and a feeling of illness (malaise) | Usually only a doctor's examination |
Chronic (lasting 8 weeks or longer) | ||
Airway irritation that remains after a respiratory tract infection resolves | A dry, nonproductive cough that occurs immediately after a respiratory tract infection No congested nose or sore throat | Sometimes only a doctor's examination, sometimes a chest x-ray |
Angiotensin-converting enzyme (ACE) inhibitors | A dry, persistent cough Use of an ACE inhibitor (cough may develop within days or months after starting the medication) | Stopping the ACE inhibitor to see whether symptoms go away |
Aspiration | A wet-sounding cough after eating or drinking, visible difficulty swallowing, or both In people who have had a stroke or another disorder that causes difficulty communicating (such as dementia), particularly among those who have a chronic cough | A chest x-ray Sometimes x-ray tests of swallowing (modified barium pharyngography) |
Asthma (cough-variant) | A cough that seems to occur after various triggers, such as exposure to pollen or another allergen, cold, or exercise Possibly wheezing and shortness of breath | Pulmonary function testing |
Chronic bronchitis (in people who smoke) | A productive cough on most days of the month for 3 months of the year for 2 successive years Frequent clearing of the throat and shortness of breath No congested nose or sore throat | Tests to evaluate how well the lungs are functioning (pulmonary function tests) |
Burning pain in the chest (heartburn) or abdomen that tends to worsen after eating certain foods, while exercising, or while lying flat A sour taste, particularly after awakening Hoarseness Wheezing A cough that occurs in the middle of the night or early morning Sometimes no symptoms other than cough | Sometimes only a doctor's examination Sometimes use of medications that suppress acid, such as a histamine-2 (H2) blocker or proton pump inhibitor, to see whether symptoms go away Sometimes insertion of a flexible viewing tube into the esophagus and stomach (endoscopy) Sometimes placement of a sensor in the esophagus to monitor acidity (pH) for 24 hours | |
Shortness of breath of gradual onset Dry cough Previous exposure to certain medications or an occupational exposure Sometimes a family history of the disorder | Chest x-ray CT of the chest Pulmonary function testing | |
A lung tumor† | A cough that sometimes produces blood A change in a chronic cough Weight loss, fever, and night sweats Enlarged, firm, painless lymph nodes in the neck | A chest x-ray Often CT of the chest Often bronchoscopy |
Postnasal drip | Headache, sore throat, and a congested nose with pale, swollen mucosa Sometimes a drip visible at the back of the throat | Sometimes only a doctor's examination Sometimes use of antihistamines and decongestants to see whether symptoms go away Sometimes allergy testing |
Tuberculosis or fungal infections† | A cough that sometimes produces blood Weight loss, fever, and night sweats Exposure to someone with tuberculosis Residence in or travel to an area where tuberculosis or fungal lung infections are common Presence of HIV infection or risk factors for HIV infection | A chest x-ray Skin testing and, if positive, examination and culture of sputum Sometimes CT of the chest |
* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. | ||
† These causes are rare. | ||
ACE = angiotensin-converting enzyme; CT = computed tomography; HIV = human immunodeficiency virus. | ||